Diloxanide Furoate Syrup for Amoebiasis
Diloxanide furoate should be administered at 500 mg orally three times daily for 10 days in adults as a luminal amebicide following tissue-active treatment with metronidazole, or as monotherapy for asymptomatic cyst passers. 1
Treatment Algorithm
For Symptomatic Intestinal Amoebiasis (Confirmed Trophozoites)
Initial tissue-active therapy:
- Adults: Metronidazole 750 mg three times daily for 5-10 days 2, 1
- Children: Metronidazole 30 mg/kg/day for 5-10 days 2, 1
Mandatory follow-up luminal therapy (after metronidazole completion):
- Diloxanide furoate 500 mg orally three times daily for 10 days to eliminate intestinal cysts and prevent relapse 1
- Alternative: Paromomycin 30 mg/kg/day orally in 3 divided doses for 10 days 1
For Asymptomatic Cyst Passers
Diloxanide furoate monotherapy is the treatment of choice:
- 500 mg orally three times daily for 10 days 1, 3
- Achieves 86-93% parasitological cure rates in asymptomatic patients 4, 5
- Significantly more effective than metronidazole/tinidazole for asymptomatic carriage (93% vs 29-56% cure rates) 4
Pediatric Dosing Considerations
While the evidence primarily describes adult dosing at 500 mg three times daily, children may require weight-based dosing adjustments though specific pediatric syrup dosing is not explicitly detailed in the available guidelines 5. The drug is particularly well tolerated in children aged 20 months to 10 years, with only 3% reporting adverse effects compared to 12% in adults 5.
Safety Profile
Common adverse effects (reported in 14% of treatment courses): 5
- Flatulence (most common)
- Diarrhea or cramping
- Nausea
- Headache (less common)
- Disorientation, dizziness, or diplopia (rare)
The drug demonstrates excellent tolerability, especially in pediatric populations 5
Critical Clinical Pitfalls
Do not use metronidazole alone for intestinal amoebiasis - it achieves only 29-56% cure rates in asymptomatic patients and requires follow-up luminal therapy 4. Failure to administer diloxanide furoate after metronidazole risks relapse from persistent intestinal cysts 1, 3.
Confirm diagnosis before treatment - only treat after microscopic identification of amebic trophozoites or after failure of two different antibiotics for presumed shigellosis 2, 1. Amebic dysentery is frequently misdiagnosed 2.
Treatment Monitoring
Assess clinical response within 2 days - if no improvement occurs, consider alternative diagnoses or drug resistance 1. Follow-up stool examination should be performed at least 14 days post-treatment to confirm parasitological cure 5.