From the Guidelines
For a 10-week-old infant with Entamoeba histolytica infection, the recommended treatment is metronidazole, 750 mg t.i.d. for 5–10 d, plus either diiodohydroxyquin, 650 mg t.i.d. for 20 d, or paromomycin, 500 mg t.i.d. for 7 d, as per the guidelines for immunocompetent patients 1.
Diagnosis and Treatment Considerations
When diagnosing Entamoeba histolytica infection in infants, it's essential to consider the risk of invasive intestinal disease and potential complications like liver abscess. The treatment should be initiated promptly to prevent severe outcomes.
- The dosage of metronidazole for infants is typically adjusted based on weight, but the provided guideline recommends a standard dose of 750 mg t.i.d. for 5–10 d 1.
- Following metronidazole treatment, a luminal agent like paromomycin is necessary to eliminate any remaining cysts and prevent further transmission.
- Proper hydration is crucial during treatment, and caregivers should monitor the infant closely for signs of dehydration, including decreased urine output, dry mouth, absence of tears when crying, and sunken fontanelle.
Prevention of Transmission
To prevent the spread of Entamoeba histolytica infection to others, caregivers should practice strict hand hygiene and proper diaper disposal.
- Breastfeeding should continue if possible, as it provides immune protection to the infant.
- Education on safe food-handling and preparation practices can help prevent future infections, especially in high-risk populations like young children and immunocompromised individuals 1.
From the FDA Drug Label
Metronidazole possesses direct trichomonacidal and amebacidal activity against T. vaginalis and E. histolytica. The in vitro minimal inhibitory concentration (MIC) for most strains of these organisms is 1 mcg/mL or less. Safety and effectiveness in pediatric patients have not been established, except for the treatment of amebiasis.
The diagnosis for a 10-week-old infant with Entamoeba histolytica infection is amebiasis. The treatment for a 10-week-old infant with Entamoeba histolytica infection is metronidazole, however, safety and effectiveness in pediatric patients have not been established, except for the treatment of amebiasis. Caution should be exercised when administering metronidazole to a 10-week-old infant due to the lack of established safety and effectiveness in this age group 2.
From the Research
Diagnosis of Entamoeba histolytica Infection
- The diagnosis of Entamoeba histolytica infection can be made through various methods, including stool examinations and serological immunoassay 3.
- A rapid and accurate gradient-based digital immunoassay system has been developed for diagnosing E. histolytica, which uses a homemade pre-coated recombinant Igl-C fragment to capture specific anti-Igl-C antibodies in the serum 3.
- Fecal samples can be tested for Entamoeba histolytica using Lugol's iodine solution and the concentration technique, as seen in a case report of a four-month-old male infant with E. histolytica infection 4.
Treatment of Entamoeba histolytica Infection
- Metronidazole is a commonly used treatment for E. histolytica infection, and has been shown to be effective in treating the infection in infants as young as four months old 4.
- However, there is a concern about the potential resistance of E. histolytica to metronidazole, and the potential for metronidazole to induce mutagenic effects and cerebral toxicity 5.
- Alternative treatments, such as flavonoids, have been investigated and show promise as a natural and safe treatment against E. histolytica 5.
- Macrolide antibiotics, such as josamycin, have also been tested for their in vitro activity against E. histolytica and may serve as a useful therapeutic agent in the presence of E. histolytica infection 6.
- In some cases, treatment with metronidazole may be followed by eradication therapy with paromomycin, as seen in a case report of a 30-year-old woman with an amoebic liver abscess 7.