Treatment involves elimination of the tissue-invading trophozoites as well as organisms in the intestinal lumen. E dispar and E moshkovskii infections do not require Treatment. Corticosteroids and antimotility drugs administered to people with amebiasis can worsen symptoms and the disease process. In settings where tests to distinguish species are not available, Treatment should be given to symptomatic people on the basis of positive results of microscopic examination. The following regimens are recommended:
- Asymptomatic cyst excreters (intraluminal infections): treat with a luminal amebicide, such as iodoquinol, paromomycin, or diloxanide.
- Patients with mild to moderate or severe intestinal symptoms or extraintestinal disease (including liver abscess): treat with metronidazole or tinidazole, followed by a therapeutic course of a luminal amebicide (iodoquinol or paromomycin). Nitazoxanide also may be effective for mild to moderate intestinal amebiasis, although it is only approved by the US Food and Drug Administration for Treatment of diarrhea caused by Giardia species or Cryptosporidium species.
Dehydroemetine followed by a therapeutic course of a luminal amebicide may be considered for patients for whom Treatment of invasive disease has failed or cannot be tolerated. However, dehydroemetine has significant toxicity and should be used with caution. An alternate Treatment for liver abscess is chloroquine phosphate concomitantly with metronidazole or tinidazole, followed by a therapeutic course of a luminal amebicide.
Surgical aspiration occasionally may be required when response of the abscess to medical therapy is unsatisfactory. To prevent spontaneous rupture of an abscess, patients with large liver abscesses may benefit from percutaneous or surgical aspiration.
Follow-up stool examination is recommended after completion of therapy, because no pharmacologic regimen is effective in eradicating intestinal infection completely. Household members and other suspected contacts also should have adequate stool examinations performed and be treated if results are positive for E histolytica
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