Treatment of Amoebiasis in Children
For children over 3 years of age with intestinal amoebiasis or amebic liver abscess, tinidazole is the first-line treatment at a dose of 50 mg/kg/day (maximum 2g) given once daily for 3 consecutive days, as it is FDA-approved for this indication and provides excellent cure rates with convenient single-daily dosing. 1, 2
First-Line Treatment: Tinidazole
- Tinidazole 50 mg/kg/day (maximum 2g) once daily for 3 days is FDA-approved for treating intestinal amebiasis and amebic liver abscess in children older than 3 years 1
- This regimen achieves cure rates of 95-97% in pediatric patients 2, 3
- For children unable to swallow tablets, tinidazole may be crushed in artificial cherry syrup and taken with food 1
- The convenience of once-daily dosing for only 3 days significantly improves adherence compared to longer regimens 2, 4
Alternative Treatment: Metronidazole
- Metronidazole 30 mg/kg/day divided into three doses for 5-10 days is the recommended alternative when tinidazole is unavailable 5
- Metronidazole cures approximately 85% of children with acute amoebic dysentery 6
- While effective, metronidazole requires longer treatment duration (5-10 days vs 3 days) and multiple daily doses, making adherence more challenging 5, 6
Critical Diagnostic Requirements
Treatment should only be initiated after confirming the diagnosis through microscopic examination of fresh stool samples showing amoebic trophozoites 5
- At least 3 stool samples should be examined, as organism shedding can be intermittent 7
- Treatment may be considered if two different antibiotics for suspected shigellosis have failed and clinical suspicion for amebiasis remains high 5
Essential Supportive Care
- Rehydration and electrolyte correction are mandatory, particularly in children with severe diarrhea 8
- Antimotility agents should be used with extreme caution in young children 7
- Nutritional supplementation should be provided as needed 7
Important Limitations and Caveats
- Tinidazole is NOT indicated for asymptomatic cyst passage—these patients require a luminal agent like paromomycin or iodoquinol 1
- For children under 3 years of age, tinidazole safety and efficacy have not been established; metronidazole becomes the preferred option 1
- Partners or household contacts should be evaluated and treated if infected to prevent reinfection 1
- Patients on hemodialysis require an additional half-dose of tinidazole after dialysis 1
Treatment Monitoring
- Follow-up stool examinations should be performed on days 4,15, and 22 after treatment completion to confirm parasitological cure 3
- Clinical improvement typically occurs within 2-3 days of starting treatment 2, 3
- Mild gastrointestinal side effects (nausea, constipation) may occur but rarely require treatment discontinuation 2, 3
Special Populations
- In patients with hepatic dysfunction, tinidazole should be administered cautiously as reduced elimination may occur 1
- No dose adjustment is needed for renal impairment unless the patient is on hemodialysis 1
- Breastfeeding should be avoided during treatment and for 72 hours after the last dose of tinidazole 1