What is the treatment for amoebiasis?

Treatment of Amoebiasis

The treatment of amoebiasis consists of metronidazole 750 mg three times daily for 5-10 days for adults, followed by a luminal agent such as paromomycin or diloxanide furoate to prevent relapse. 1

Diagnosis and Initial Assessment

• Amoebiasis should be diagnosed through microscopic examination of fresh feces showing amebic trophozoites or after two different antibiotics for shigellosis have failed to produce clinical improvement 1
• Indirect hemagglutination testing has over 90% sensitivity for amoebic liver abscess and should be performed in suspected cases 1
• Ultrasound should be performed in all patients with suspected amoebic liver abscess; consider CT scan if ultrasound is negative but clinical suspicion remains high 1

Treatment Regimens

Intestinal Amoebiasis

Adults:

• Metronidazole: 750 mg three times daily for 5-10 days 1
• Tinidazole: 2 g once daily for 3 days (alternative with potentially better efficacy and fewer side effects) 2, 3

Children:

• Metronidazole: 30 mg/kg/day for 5-10 days 1
• Tinidazole: FDA approved for children older than three years of age 4

Amoebic Liver Abscess

• Same drug regimens as intestinal amoebiasis 1
• Most patients will respond within 72-96 hours of treatment initiation 1
• If systemic inflammatory response syndrome is present, consider adding broad-spectrum antibiotics (e.g., ceftriaxone) until diagnosis is confirmed 1

Follow-up Treatment (Essential)

• After completion of metronidazole or tinidazole treatment, ALL patients should receive a luminal amebicide to eliminate intestinal cysts and prevent relapse 1
• Options include:
  • Diloxanide furoate: 500 mg orally three times daily for 10 days 1
  • Paromomycin: 30 mg/kg/day orally in 3 divided doses for 10 days 1, 5

Special Considerations

• Surgical or percutaneous drainage of amoebic liver abscess is rarely required and should only be considered in cases of:

  1. Diagnostic uncertainty
  2. Persistent symptoms after 4 days of treatment
  3. Risk of imminent rupture, particularly of left-lobe abscesses that could rupture into critical sites like the pericardium 1

• Nitazoxanide is a newer agent with broad-spectrum antiparasitic activity that shows promise against both luminal and invasive forms of E. histolytica 6

Treatment Efficacy

• Tinidazole has demonstrated significantly higher cure rates (90-96.5%) compared to metronidazole (53.3-55.5%) in the treatment of symptomatic intestinal amoebiasis 2, 3
• Tinidazole is generally better tolerated than metronidazole, with fewer and less severe side effects 2, 3
• Single daily dosing with tinidazole may improve patient adherence compared to multiple daily doses of metronidazole 3

Monitoring and Complications

• Patients with moderate-to-severe disease should be monitored for clinical improvement and resolution of symptoms 1
• If symptoms persist after 4 days of appropriate treatment, consider alternative diagnoses or treatment failure 1
• Concerns about metronidazole include potential adverse effects and possible emergence of resistant strains 7

Prevention

• Emphasize hand washing after using the bathroom and before preparing or eating food 8
• Avoid consuming untreated water or uncooked food in endemic areas 1