From the Research
Paromomycin is the most effective treatment for Dientamoeba fragilis, with a clearance rate of 83%, and should be considered as the first-line option. The treatment for Dientamoeba fragilis typically involves antiparasitic medications, and the choice of medication is crucial in achieving faecal clearance and clinical cure. According to the most recent and highest quality study 1, paromomycin outperformed metronidazole, secnidazole, and doxycycline in terms of faecal clearance and clinical cure.
Key Points to Consider
- The study found that paromomycin had a strong association with faecal clearance (aOR 18.08 [7.24-45.16], p < 0.001) and clinical cure (aOR 5.85 [3.02-11.32], p < 0.001) 1.
- Metronidazole, which was previously considered a first-line option, had a lower clearance rate of 42% compared to paromomycin 1.
- The study suggests that faecal clearance is strongly associated with clinical cure, and paromomycin is the most effective option in achieving this outcome 1.
- Other studies have also reported the effectiveness of paromomycin in treating Dientamoeba fragilis infections, with a study from 2019 finding that paromomycin was more effective than metronidazole in eradicating the parasite (81.8% vs. 65.4%; p = 0.007) 2.
Treatment Recommendations
- Paromomycin should be considered as the first-line treatment option for Dientamoeba fragilis infections, given its high clearance rate and strong association with clinical cure.
- The dosage of paromomycin recommended is 25-35 mg/kg/day in three doses for 7 days.
- Patients should maintain good hydration and may need symptomatic relief for diarrhea or abdominal discomfort during treatment.
- Follow-up stool testing may be performed 2-4 weeks after treatment completion to confirm eradication.