Amebiasis (amebic dysentery)

Amebiasis is an intestinal illness caused by a microscopic parasite called Entamoeba

histolytica.,a protozoal disease,
Amebiasis is most prevalent in tropical and subtropical countries where standards of
public hygiene and sanitation may be low.

Symptoms of Amebiasis
Some strains of amebae are harmless but others, for unknown reasons, invade the
intestinal wall, causing mucus secretion into the intestines and diarrhea - an illness called
amebic dysentery. Additional symptoms may include fever, and abdominal cramping and
pain.
In severe cases, ulcers may form in the intestinal wall; the amebae gain access to the
bloodstream and travel to the liver to form abscesses.
The symptoms may appear from a few days to a few months after exposure but usually
within two to four weeks.

Diagnosis of Amebiasis
Diagnostic tools may include:

• Medical history, physical examination, lab tests, and stool studies

• Blood tests for revealing antibodies to the organism

• Sigmoidoscopy to evaluate the intestinal wall

• Radiological studies including ultrasound and CT (computed tomography) scans

to detect liver abscesses
Examination of stools under a microscope is the most common way for a doctor to
diagnose amebiasis

Treatment of Amebiasis
The choice of drug depends on the type of clinical presentation and the site of drug action
(in the intestinal wall versus inside the intestine itself). Drugs may include metronidazole,
paromomycin, iodoquinol, or diloxanide furoate. These drugs have side effects that your
physician can discuss with you.
Occasionally, it may be necessary to drain a liver abscess.
Follow-up care includes stool studies 2 to 4 weeks after completing treatment.
Prevention of Amebiasis
Travelers to countries where sanitary standards are low can reduce their chances of
acquiring amebiasis by:

• Drinking only water that has been bottled in sanitary conditions or boiled (water-
purifying tablets are ineffective against amebic cysts)

• Eating only cooked or peeled vegetables or fruits

• Protecting food from fly contamination

• Washing hands after defecation and before preparing or eating food

The most important precautions are careful handwashing after each toilet visit and proper
disposal of sewage
Do not eat or drink milk, cheese, or dairy products that may not have been pasteurized.
DRUGS

Metronidazole
Metronidazole is effective therapy against protozoa such as Trichomonas vaginalis,
amebiasis, and giardiasis.anaerobic bacterial infections,in treating Crohn's disease,
antibiotic-associated diarrhea, and rosacea
It acts selectively aganist anaerobic bacterias as only these bacteria are capabale to reduce
it to its active form intracellularly. Reduced it then disrupts DNA's helical structure,
thereby inhibiting bacterial nucleic acid synthesis. This eventually results in bacterial cell
death.
PharmacoKinetics
Oral absorption of Metronidazole is found to be 95% . Volume of distribution is found to
be 0.76 - 1.02 l/kg and plasma protien binding is 10 %. and metabolism is reported
Hepatic. Renal Excretion accounts for 80 % and plasma half life is 7.9 - 9.8 hr.
Indications
Metronidazole is primarily indicated in conditions like Acute dental infections,
HYPERLINK "Disease.aspx?Code=3305"Acute ulcerative gingivitis, HYPERLINK
"Disease.aspx?Code=569"Amoebiasis, HYPERLINK "Disease.aspx?
Code=1616"Anaerobic bacterial infection, HYPERLINK "Disease.aspx?
Code=3292"Anaerobic infections, HYPERLINK "Disease.aspx?Code=1675"Dysentery,
HYPERLINK "Disease.aspx?Code=1052"Giardiasis, HYPERLINK "Disease.aspx?
Code=3962"Lung cancer and pancreatic cancer, HYPERLINK "Disease.aspx?
Code=1609"Pelvic inflammatory disease, HYPERLINK "Disease.aspx?
Code=126"Protozoa infection, HYPERLINK "Disease.aspx?Code=3431"Schizophrenia
and other psychoses, HYPERLINK "Disease.aspx?Code=1700"Surgical prophylaxis,
HYPERLINK "Disease.aspx?Code=3964"Treatment of locally advanced or metastatic
pancreatic cancer, HYPERLINK "Disease.aspx?Code=1053"Trichomoniasis,
HYPERLINK "Disease.aspx?Code=3302"Urogenital trichomoniasis, and can also be
given in adjunctive therapy as an alternative drug of choice in

if infection occur, then metronidazole administer with diloxanide furoate.

but for prophyloxis, inly metronidazole, 75mg/kg/8hourly/i.v or 500mg/i.v/ 8hourly
Contra Indication
Metronidazole is contraindicated in conditions like
Interaction
Metronidazole is known to interact with other drugs like Alprazolam, Carbamazepine,
HYPERLINK "Drug.aspx?intDrug=Cimetidine
(HCl)&selection=479%2C173&flag=true&drugCode=479&drugName=Metronidazole&
type=13&interactingDrugs=Metronidazole with Cimetidine (HCl)"Cimetidine (HCl),
Disulfiram, Disulfiram, Fluorouracil, Nicoumalone, Phenindione, Phenytoin (Na),
HYPERLINK "Drug.aspx?
intDrug=Podophyllum&selection=479%2C584&flag=true&drugCode=479&drugName
=Metronidazole&type=13&interactingDrugs=Metronidazole with
Podophyllum"Podophyllum, Ritonavir, Stavudine, Warfarin (Na), Zalcitabine.
These interactions are sometimes beneficial and sometimes may pose threats to life.
Always consult your physician for the change of dose regimen or an alternative drug
of choice that may strictly be required.

enzym inducer drugs inc. metabolism thus dec b.a, like phenobarbitol
enzyme inhibitor drugs ,prolong the plasma half-life. like cimetidine
Side Effects
The severe or irreversible adverse effects of Metronidazole, which give rise to further
complications include Encephalopathy, Ataxia, Neutropenia, Seizures.

The signs and symptoms that are produced after the acute overdosage of
Metronidazole include Disorientation.

The symptomatic adverse reactions produced by Metronidazole are more or less

tolerable and if they become severe, they can be treated symptomatically, these
include Dry mouth, Maculopapular rash, GI upset, Nausea and vomiting,
Gynecomastia, Metallic taste, Acute pancreatitis, Darkening of urine.
Available Brands
Single Ingredient
Inj: 500 mg, 10 mg/ml,
Inf: 5 mg/ml,
Susp: 200 mg, 200 mg/5ml,
Cream: 0.75 %w/w,
Gel: 0.75 %w/w,
Tabs: 50 mg, 200 mg, 250 mg, 400 mg, 500 mg,
Tabs DS: 400 mg,
Vag Tabs: 500 mg,

Multi ingredient
Inj: 1"5 mg/ml,
Susp: 1"75 mg/5ml, 1"100 mg/5ml, 1"200 mg/5ml, 1"250 mg/5ml, 1"321.6 mg/5ml,
Tabs: 1"100 mg, 1"200 mg, 1"250 mg, 1"300 mg, 1"400 mg
High Risk Group
Drug should not be given to Pregnant Mothers, and patients suffering from Liver
Malfunction.
If prescribing authority justifies the benefits of the drug against the possible damages
he/she should reevaluate them and consult the reference material and previous studies.
Warnings / Precautions
Metronidazole should be used with caution in patients with any allergy. Avoid use during
pregnancy or lactation. Avoid alcoholic beverages while taking this medication as severe
stomach upset, nausea, vomiting, headache and flushing can occur.
Storage Condidtions
Tab, Susp, Inj : Store Below 40°C. Protect from Sunlight
LUMINAL AMEBICIDES:

Diloxanide (Furoate)
dichloroacetamide derivative
treatment of intestinal amebiasis (dysentery) in combination with other drugs.
PharmacoKinetics

Oral absorption of Diloxanide (Furoate) is found to be 2.5% ±2.5. Presystemic

metabolism is noted to be 92.5% ±2.5 and metabolism is reported via Intestine. Renal
Excretion accounts for rapid and plasma half life is short.
Indications
Diloxanide (Furoate) is primarily indicated in conditions like Asymptomatic cyst
passers, HYPERLINK "Disease.aspx?Code=2643"Mild amebic dysentery, HYPERLINK
"Disease.aspx?Code=2642"Non-dysenteric intestinal amebiasis, HYPERLINK
"Disease.aspx?Code=3953"Oliguria due to renal failure, HYPERLINK "Disease.aspx?
Code=3953"Oliguria due to renal failure, HYPERLINK "Disease.aspx?
Code=115"Parkinsonism

Side Effects
The symptomatic adverse reactions produced by Diloxanide (Furoate) are more or less
tolerable and if they become severe, they can be treated symptomatically, these include
Flatulence, Nausea, Vomiting, Anorexia, Diarrhea, Abdominal cramps, Urticaria,
Esophagitis, Paresthesias, Albuminuria.

Available Brands
Multi ingredient
Susp: 1"125 mg/5ml, 1"250 mg/5ml,
Tabs: 1"250 mg, 1"500 mg,

Dosage
Diloxanide (Furoate) 's dosage details are as follows:

Dose Single Dose Frequency Route Instructions

Adult Dosage ( >12 years. )

500.000 mg 500 (500) 8 hourly PO For 10 Days

Paedriatic Dosage ( 20 Kg. )

Recommended for 5-
7.500 mg/kg 150 (150) 8 hourly Oral
12 Yrs of Children

High Risk Group

Drug should not be given to Pregnant Mothers, and Neonates.
If prescribing authority justifies the benefits of the drug against the possible damages
he/she should reevaluate them and consult the reference material and previous studies.
Warnings / Precautions
Diloxanide should be used with caution in patient with symptomatic intestinal amebiasis
or extra-intestinal amebiasis, during pregnancy and in childrens less than 2 years of age.
Storage Condidtions
Tab : Store in a well closed container, Below 40°C. Protect from Sunlight