Most cases of amoebic dysentery respond to a single adequate course of treatment. Metronidazole/tinidazole are the drugs of choice. Secnidazole, ornidazole, satranidazole are the alternatives.
NOTES ON THE TREATMENT OF AMOEBIASIS
1. Invasive Intestinal Amoebiasis
Most cases of amoebic dysentery respond to a single
adequate course of treatment. Metronidazole/tinidazole are the drugs of choice.
Secnidazole, ornidazole, satranidazole are the alternatives. Adjuvant measures
for diarrhoea and abdominal pain may be needed. Dehydroemetine is rarely used
in the most severe cases to accord faster symptomatic relief. It should be
discontinued as soon as acute symptoms are controlled (2–3 days) and metronidazole
started. Emetine may also be needed when metronidazole is contraindicated or
produces rashes/neurotoxicity.
The above treatment should be followed by a course of luminal
amoebicide to eradicate E. histolytica from
the colon and to prevent carrier (cyst
passing) state.
2. Chronic Intestinal
Amoebiasis/Asymptomatic Cyst Passers
These cases are more difficult to treat,
two or more repeated courses may be needed. Diloxanide furoate produces high
cure rates and is the drug of choice. Nitazoxanide is an alternative.
Metronidazole/tinidazole may be given in alternating courses, but are less
effective in clearing cysts; they would though cure any latent hepatic
infection. A single course of a hydroxyquinoline not extending beyond 2 weeks
may be used as third choice.
A tetracycline may be given concurrently with the luminal
amoebicide in cases which fail to clear completely.
3. Amoebic Liver Abscess
It is a serious disease; complete
eradication of trophozoites from the liver is essential to avoid relapses.
Metronidazole/tinidazole are the first choice drugs effective in > 95%
cases. Dehydroemetine is to be used only if metronidazole cannot be given for
one reason or the other, and in patients not cured by metronidazole. If a big
abscess has formed, it may be aspirated.
A luminal amoebicide must be given later to finish the
intestinal reservoir of infection. A course of chloroquine may be administered
after that of metronidazole/dehydroemetine in those with incomplete response or
to ensure that no motile forms survive in the liver.
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