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Clinical Spectrum of Amebiasis in Children
Published in Roberto R. Kretschmer, Amebiasis: Infection and Disease by Entamoeba histolytica, 2020
A child may continue excreting E. histolytica cysts after therapy with emetine and in up to 20% of the cases even after therapy with metronidazole.44 If this situation arises it may be necessary to administer a drug with luminal action: (1) oral diiodohydroxyquin, 30 mg/kg/day, t.i.d. for 20 days with a maximal daily dose of 2 g; or (2) oral diloxanide fuorate, 20 mg/kg/day, t.i.d. for 10 days with a maximal daily dose of 1.5 g.
Tropical infections and infestations
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Medical treatment is very effective and should be the first choice in the elective situation, with surgery being reserved for complications. Metronidazole and tinidazole are the effective drugs. After treatment with metronidazole and tinida- zole, diloxanide furoate, which is not effective against hepatic infestation, is used for 10 days to destroy any intestinal amoebae.
Diloxanide Furoate
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Jared E. Eisemann, Paul M. Griffin
Diloxanide furoate is active against the protozoan parasite E. histolytica within the intestinal lumen. It is used for treating asymptomatic (or only mildly symptomatic) patients passing cysts. Patients should ideally be confirmed to be infected with E. histolytica rather than the morphologically identical but nonpathogenic ameba species Entamoeba dispar or Entamoeba moshkovskii (Knight, 1980; WHO/PAHO/UNESCO, 1997; Haque et al., 2003; Ayed et al., 2008). The drug is not effective in patients with invasive amebic colitis and is of no value in treating extraintestinal amebiasis because it has little or no activity outside the intestinal lumen (Botero, 1964). Diloxanide furoate has been shown in vitro to have little or no effect on other intestinal protozoan parasites including Dientamoeba fragilis (Nagata et al., 2012) and Blastocystis hominis (Zierdt et al., 1983).
The management of Babesia, amoeba and other zoonotic diseases provoked by protozoa
Published in Expert Opinion on Therapeutic Patents, 2023
Clemente Capasso, Claudiu T. Supuran
Although there are ongoing studies, there is currently neither a vaccine nor a wide range of medications that are effective against amebiasis, which remains one of the most severe enteropathogens worldwide [38]. Patients with the clinical disease can be treated with an amoebicidal tissue-active agent or a luminal cysticidal agent to stop the infection and avoid further infections [47,48]. The amoebicidal drug includes the nitroimidazole agents, such as metronidazole 13 and tinidazole 14 (Figure 3), which are the treatment of choice for amebic colitis and amebic liver disease due to their potency against the parasites’ reproductive stages (trophozoites) [47,48]. Tinidazole has a longer half-life and is better tolerated, although metronidazole kills the parasites more efficiently [47,48]. It is necessary to use a luminal agent after using nitroimidazole because it does not eradicate luminal cysts [49–51]. The aminoglycoside paromomycin 15 is utilized as a luminal cysticidal agent, which should not be provided concurrently with the nitroimidazole agent [52]. Alternatives include diloxanide furoate 16 and iodoquinol 17 (Figure 3) [38]. Recently, auranofin, a gold compound used to treat particular cases of rheumatoid arthritis, has entered early clinical drug development as an antiparasitic agent [53]. However, more research is needed to evaluate if auranofin would be a successful treatment of amebiasis and if its usage will be limited by known safety issues such as diarrhea, rash, and bone marrow suppression [53].
Overcoming challenges in the diagnosis and treatment of parasitic infectious diseases in migrants
Published in Expert Review of Anti-infective Therapy, 2020
Francesca F. Norman, Belen Comeche, Sandra Chamorro, Rogelio López-Vélez
Adequate therapy for amoebic colitis is necessary to reduce disease burden, prevent the development of complications and reduce transmission [101]. All infections caused by E. histolytica, even in asymptomatic carriers, should thus receive specific treatment, due to the potential development of invasive disease and to diminish spread [98]. Treatment options can be divided into luminal agents (paromomycin, diloxanide furoate, iodoquinol) and tissue agents (metronidazole, tinidazole, nitazoxanide). Patients with asymptomatic amebiasis need only be treated with a luminal agent to prevent invasion and transmission, while patients with clinical disease require treatment with an agent active in tissues followed by a luminal agent [97]. A recent Cochrane Review demonstrated that tinidazole may be more effective in reducing clinical failure in amoebic colitis and may be associated with fewer adverse events, compared with metronidazole. Also, combination drug therapy may be more effective in reducing parasitological failure compared with metronidazole alone but data are currently insufficient to recommend a specific combination [101]. Paromomycin should not be administered at the same time as the nitroimidazole agent as it may cause diarrhea. Drainage of liver abscesses (either image-guided or open aspiration) may occasionally be required in addition to antiparasitic therapy [97].
Diloxanide furoate binary complexes with β-, methyl-β-, and hydroxypropyl-β-cyclodextrins: inclusion mode, characterization in solution and in solid state and in vitro dissolution studies
Published in Pharmaceutical Development and Technology, 2018
Carolina Aloisio, Marcela Longhi
Pathogenic intestinal protozoa are responsible for clinically important infections in both the developed and the developing world. Amoebiasis affects around 480 million people worldwide, with an annual mortality of 40 000–110 000 persons. These organisms are responsible for both acute and chronic diarrhea, and Entamoeba histolytica, which affects the colon, can spread to involve the liver. Acute amebic colitis ranges from mild to severe, and can be fulminant, leading to colon perforation. The infection can spread from the liver by direct extension into the pleuropulmonary cavity and the pericardial cavity. Occasionally, and most often in immuno-suppressed individuals, the infection might be widely disseminated and affect other organs, including bones and the brain (Farthing 2006). Diloxanide furoate (DF) (Figure 1(a)) is one of the drugs of choice for the treatment of amebic colitis caused by Entamoeba histolytica (Budal et al. 2004; Mishal and Sober 2005; Farthing 2006). DF acts on organisms in the intestinal lumen (Farthing 2006). For this reason, high concentrations of this drug in the intestinal fluids are substantially related to the effectiveness of the drug. Orally administered drugs must have sufficient water solubility to ensure their bioavailability and pharmacological activity (Ojarinta et al. 2017). However, DF presents little solubility in water, which can affect its action against Entamoeba histolytica (Budal et al. 2004). Accordingly, the use of suitable strategies to increase water solubility of DF and dissolution rate in the intestinal fluids may reduce the possibility of the drug precipitating in the lumen, and this would lead to a loss in effectiveness.