Treatment of amoebiasis with drugs

Treatment of amebiasis is carried out with drugs that can be divided into two groups - contact (luminal), affecting intestinal luminal forms, and systemic tissue amoebicides.

Drug treatment of amebiasis

Treatment of non-invasive amebiasis (asymptomatic carriers) is performed using luminal amebicides. They are also recommended to be prescribed after completion of treatment with tissue amebicides to eliminate amoebas that may have remained in the intestine. If it is impossible to prevent re-infection, the use of luminal amebicides is inappropriate. In these situations, luminal amebicides should be prescribed according to epidemiological indications, for example, to persons whose professional activities may contribute to the infection of other people, in particular, employees of food establishments.

Treatment of invasive amebiasis involves the use of systemic tissue amebicides. The drugs of choice are 5-nitroimidazoles: metronidazole, tinidazole, ornidazole. They are used to treat both intestinal amebiasis and abscesses of any localization. In addition to drugs from the 5-nitroimidazole group, emetine and chloroquine are sometimes used to treat invasive amebiasis, and especially amoebic liver abscesses. Drugs from the 5-nitroimidazole group are well absorbed and are usually prescribed orally. Parenteral (intravenous) administration of these drugs is used to treat extraintestinal amebiasis, as well as in seriously ill patients or when oral administration is impossible. Due to possible serious side effects, primarily the cardiotoxic effect, emetine is considered a reserve drug and is recommended for intramuscular administration to patients with extensive abscesses, as well as to patients in whom previous courses of 5-nitroimidazoles have been ineffective. Chloroquine is prescribed in combination with emetine in the treatment of amoebic liver abscesses.

Chemotherapy drugs used to treat amebiasis

	5-Nitroimidazoles	Luminal amoebicides	Emetine	Chloroquine
Non-invasive amoebiasis (carrier state)		-
Intestinal amoebiasis	-	-	-
Extraintestinal amoebiasis	+	+	+	+

Antiparasitic treatment of invasive intestinal amoebiasis involves the use of the following drugs:

• metronidazole - 30 mg/kg per day in three doses for 8-10 days;
• tinidazole - 30 mg/kg once a day for 3 days;
• ornidazole - 30 mg/kg once daily for 5 days.

For the treatment of patients with amoebic abscesses of the liver and other organs, the same drugs from the 5-nitroimidazole group are used in longer courses:

• metronidazole - 30 mg/kg per day intravenously or orally in three doses for 10 days;
• tinidazole - 30 mg/kg once a day for 10 days;
• ornidazole - 30 mg/kg once daily for 10 days.

Alternative treatment for amoebic liver abscess involves the use of:

• emetine - 1 mg/kg per day once intramuscularly (no more than 60 mg/day) for 4-6 days:
• chloroquine base - 600 mg per day for 2 days, then 300 mg for 2-3 weeks - simultaneously with or immediately after completion of the course of emetine.

After completion of the course of treatment with systemic tissue amoebicidal drugs, the following luminal amoebicides are used to destroy the remaining amoebas in the intestine:

• diloxanide furoate - 500 mg 3 times a day, 10 days (for children 20 mg/kg per day);
• etofamide - 20 mg/kg per day in 2 doses for 5-7 days;
• paromomycin - 1000 mg per day in 2 doses for 5-10 days.

These same drugs are used to treat parasite carriers.

For seriously ill patients with amoebic dysentery, due to possible intestinal perforation and development of peritonitis, it is recommended to additionally prescribe drugs from the tetracycline group (doxycycline 0.1 g once a day).

After successful chemotherapy of liver abscess, residual cavities usually disappear within 2-4 months, but sometimes later.

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Adjunctive treatment for amebiasis

Aspiration (or percutaneous drainage) of an abscess is recommended for large sizes (more than 6 cm in diameter), localization of the abscess in the left lobe or high in the right lobe of the liver, severe abdominal pain and tension of the abdominal wall, in which there is a risk of rupture of the abscess, as well as in cases where chemotherapy is ineffective within 48 hours after its start.

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Clinical examination

Outpatient monitoring of those who have recovered continues for a year. During this period, medical examinations and laboratory tests are carried out every 3 months.

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