Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

symptomatic amoebiasis

1st line – nitroimidazole

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ACUTE
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symptomatic amoebiasis
1st line – 

nitroimidazole

Treatment should be given as soon as the diagnosis is considered, after samples have been taken for testing, as amoebiasis is a potentially fatal illness.[1][5]

Nitroimidazoles (e.g., metronidazole, tinidazole) have excellent tissue penetration and are active for both luminal and invasive infection.[7][17]​​

Treatment with a nitroimidazole is followed with a luminal agent to eliminate intestinal colonisation.[7]​​​[17][34][35]

Adverse effects are generally minor, whereas the infection itself is potentially fatal.

Primary options

metronidazole: children: 35-50 mg/kg/day orally given in 3 divided doses for 7-10 days; adults: 500-750 mg orally three times daily for 7-10 days

OR

tinidazole: children: 50 mg/kg orally once daily for 3 days (or 5 days if liver abscess), maximum 2000 mg/day; adults: 2000 mg orally once daily for 3 days (or 5 days if liver abscess)

Plus – luminal agent

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ACUTE
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symptomatic amoebiasis
Plus – 

luminal agent

Treatment recommended for ALL patients in selected patient group

Luminal agents are used after completion of acute therapy with the nitroimidazole to eradicate gut infection and thereby reduce the risk of a relapse of infection.[35]

Paromomycin is the first-line luminal agent.[7]​[17]​​

Primary options

paromomycin: children and adults: 25-35 mg/kg/day orally given in 3 divided doses for 5-10 days

Consider – aspiration

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ACUTE
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symptomatic amoebiasis
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liver abscess that does not respond to nitroimidazole after 5-7 days, large (>5 cm diameter) or left lobe lesions
Consider – 

aspiration

Additional treatment recommended for SOME patients in selected patient group

Percutaneous aspiration of an amoebic abscess is not commonly required, but may be indicated for patients who do not respond to nitroimidazole treatment in 5 to 7 days, or those with large (>5 cm diameter) or left lobe lesions. In patients with large abscesses, draining the abscess in addition to treating with a nitroimidazole could aid in the early resolution of pain and tenderness.​​[1][2][5]​​​​​[37][38]​​​

asymptomatic amoebiasis

1st line – luminal agent

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ACUTE
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asymptomatic amoebiasis
1st line – 

luminal agent

Asymptomatic patients require treatment because of the risk of developing future invasive disease.[1][5] They should be treated with a luminal agent alone.[7][36]​​

Paromomycin is the first-line luminal agent.[7][17]​​

Primary options

paromomycin: children and adults: 25-35 mg/kg/day orally given in 3 divided doses for 5-10 days

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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