Treatment of amebiasis with drugs

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

Medication for amebiasis

Treatment of non-invasive amoebiasis (asymptomatic carriers) occurs using luminal amoebicides. They are recommended to be prescribed also after the end of the treatment with tissue amoebicides for elimination of amoebas, possibly remaining in the intestine. If it is impossible to prevent re-infection, the use of luminal amoebicides is impractical. In these situations, luminal amoebicides should be prescribed for epidemiological reasons, for example, individuals whose professional activities may contribute to the infection of other people, in particular employees of catering enterprises.

Treatment of invasive amoebiasis involves the use of systemic tissue amoebicides. 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 preparations from the group of 5-nitroimidazoles, for the treatment of invasive amebiasis. And primarily amebic liver abscesses, sometimes use emetine and chloroquine. Preparations of the 5-nitroimidazoles group are well absorbed, and, as a rule, they are prescribed inside. Parenteral (intravenous) administration of these drugs is used in the treatment of extraintestinal amebiasis, as well as in severe patients or when it is not possible to take orally. Due to possible serious adverse reactions, especially the cardiotoxic effect, emetine is referred to reserve drugs, it is recommended to inject it intramuscularly to patients with extensive abscesses, as well as patients whose previous courses of 5-nitroimidazoles were ineffective. Chloroquine is prescribed in combination with emetin in the treatment of amebic liver abscesses.

Chemotherapy drugs used to treat amebiasis

	5-Nitroimidazoles	Enlightened amoebicides	Emetine	Chlorokhin
Non-invasive amebiasis (carriage)		-
Intestinal amebiasis	-	-	-
Extraintestinal amebiasis	+	+	+	+

Antiparasitic treatment of amoebiasis of the invasive intestinal is to use 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 a day for 5 days.

For treatment of patients with amebic abscesses of the liver and other organs, the same drugs from the 5-nitroimidazoles group are used with 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 a day for 10 days.

Alternative treatment of amebic liver abscess involves the use of:

• emetin - 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 or immediately after the completion of the course of emetine.

After the completion of the course of treatment with systemic tissue amebocidal preparations, the following luminal amoebicides are used to kill the remaining amoebas in the intestine:

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

The same drugs are used for sanitation of parasites.

Severe patients with amebic dysentery due to possible intestinal perforation and the development of peritonitis are recommended to additionally prescribe tetracycline group (doxycycline 0.1 g once daily).

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

[1], [2], [3], [4], [5], [6]

Additional treatment for amebiasis

Aspiration (or percutaneous drainage) of the abscess is recommended for larger 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 abdominal wall tension, at which the risk of abscess rupture is likely, as well as in cases where chemotherapy is ineffective within 48 hours after its onset.

[7], [8], [9]

Clinical examination

Dispensary follow-up for those who have been ill continue for a year. During this period, medical examinations and laboratory tests are carried out every 3 months.

[10], [11], [12]