Amoebiasis
- Overview
- Theory
- Diagnosis
- Management
- Follow up
- Resources
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
symptomatic amoebiasis
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]Haque R, Huston CD, Hughes M, et al. Amebiasis. New Engl J Med. 2003;348:1565-73. http://www.ncbi.nlm.nih.gov/pubmed/12700377?tool=bestpractice.com [5]Stanley SL Jr. Amoebiasis. Lancet. 2003;361:1025-34. http://www.ncbi.nlm.nih.gov/pubmed/12660071?tool=bestpractice.com
Nitroimidazoles (e.g., metronidazole, tinidazole) have excellent tissue penetration and are active for both luminal and invasive infection.[7]Shirley DT, Farr L, Watanabe K, et al. A review of the global burden, new diagnostics, and current therapeutics for amebiasis. Open Forum Infect Dis. 2018 Jul;5(7):ofy161. https://academic.oup.com/ofid/article/5/7/ofy161/5049601 http://www.ncbi.nlm.nih.gov/pubmed/30046644?tool=bestpractice.com [17]Centers for Disease Control and Prevention. CDC Yellow Book 2026: health information for international travel. Section 5: travel-associated infections & diseases - post-travel diarrhea. Apr 2025 [internet publication]. https://www.cdc.gov/yellow-book/hcp/post-travel-evaluation/post-travel-diarrhea.html
Treatment with a nitroimidazole is followed with a luminal agent to eliminate intestinal colonisation.[7]Shirley DT, Farr L, Watanabe K, et al. A review of the global burden, new diagnostics, and current therapeutics for amebiasis. Open Forum Infect Dis. 2018 Jul;5(7):ofy161. https://academic.oup.com/ofid/article/5/7/ofy161/5049601 http://www.ncbi.nlm.nih.gov/pubmed/30046644?tool=bestpractice.com [17]Centers for Disease Control and Prevention. CDC Yellow Book 2026: health information for international travel. Section 5: travel-associated infections & diseases - post-travel diarrhea. Apr 2025 [internet publication]. https://www.cdc.gov/yellow-book/hcp/post-travel-evaluation/post-travel-diarrhea.html [34]Drugs for parasitic infections. Medical Letter. 2004;46:e1-12.[35]Gonzales MLM, Dans LF, Sio-Aguilar J. Antiamoebic drugs for treating amoebic colitis. Cochrane Database Syst Rev. 2019 Jan 9;1:CD006085. https://www.doi.org/10.1002/14651858.CD006085.pub3 http://www.ncbi.nlm.nih.gov/pubmed/30624763?tool=bestpractice.com
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)
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]Gonzales MLM, Dans LF, Sio-Aguilar J. Antiamoebic drugs for treating amoebic colitis. Cochrane Database Syst Rev. 2019 Jan 9;1:CD006085. https://www.doi.org/10.1002/14651858.CD006085.pub3 http://www.ncbi.nlm.nih.gov/pubmed/30624763?tool=bestpractice.com
Paromomycin is the first-line luminal agent.[7]Shirley DT, Farr L, Watanabe K, et al. A review of the global burden, new diagnostics, and current therapeutics for amebiasis. Open Forum Infect Dis. 2018 Jul;5(7):ofy161. https://academic.oup.com/ofid/article/5/7/ofy161/5049601 http://www.ncbi.nlm.nih.gov/pubmed/30046644?tool=bestpractice.com [17]Centers for Disease Control and Prevention. CDC Yellow Book 2026: health information for international travel. Section 5: travel-associated infections & diseases - post-travel diarrhea. Apr 2025 [internet publication]. https://www.cdc.gov/yellow-book/hcp/post-travel-evaluation/post-travel-diarrhea.html
Primary options
paromomycin: children and adults: 25-35 mg/kg/day orally given in 3 divided doses for 5-10 days
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]Haque R, Huston CD, Hughes M, et al. Amebiasis. New Engl J Med. 2003;348:1565-73. http://www.ncbi.nlm.nih.gov/pubmed/12700377?tool=bestpractice.com [2]Petri WA Jr, Singh U. Diagnosis and management of amebiasis. Clin Infect Dis. 1999;29:1117-25. http://www.ncbi.nlm.nih.gov/pubmed/10524950?tool=bestpractice.com [5]Stanley SL Jr. Amoebiasis. Lancet. 2003;361:1025-34. http://www.ncbi.nlm.nih.gov/pubmed/12660071?tool=bestpractice.com [37]Chavez-Tapia NC, Hernandez-Calleros J, Tellez-Avila FI, et al. Image-guided percutaneous procedure plus metronidazole versus metronidazole alone for uncomplicated amoebic liver abscess. Cochrane Database Syst Rev. 2009;(1):CD004886. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004886.pub2/full http://www.ncbi.nlm.nih.gov/pubmed/19160244?tool=bestpractice.com [38]Bammigatti C, Ramasubramanian NS, Kadhiravan T, et al. Percutaneous needle aspiration in uncomplicated amebic liver abscess: a randomized trial. Trop Doct. 2013;43:19-22. http://www.ncbi.nlm.nih.gov/pubmed/23550199?tool=bestpractice.com
asymptomatic amoebiasis
luminal agent
Asymptomatic patients require treatment because of the risk of developing future invasive disease.[1]Haque R, Huston CD, Hughes M, et al. Amebiasis. New Engl J Med. 2003;348:1565-73. http://www.ncbi.nlm.nih.gov/pubmed/12700377?tool=bestpractice.com [5]Stanley SL Jr. Amoebiasis. Lancet. 2003;361:1025-34. http://www.ncbi.nlm.nih.gov/pubmed/12660071?tool=bestpractice.com They should be treated with a luminal agent alone.[7]Shirley DT, Farr L, Watanabe K, et al. A review of the global burden, new diagnostics, and current therapeutics for amebiasis. Open Forum Infect Dis. 2018 Jul;5(7):ofy161. https://academic.oup.com/ofid/article/5/7/ofy161/5049601 http://www.ncbi.nlm.nih.gov/pubmed/30046644?tool=bestpractice.com [36]Blessmann J, Tannich E. Treatment of asymptomatic intestinal Entamoeba histolytica infection. N Engl J Med. 2002;347:1384. http://www.ncbi.nlm.nih.gov/pubmed/12397207?tool=bestpractice.com
Paromomycin is the first-line luminal agent.[7]Shirley DT, Farr L, Watanabe K, et al. A review of the global burden, new diagnostics, and current therapeutics for amebiasis. Open Forum Infect Dis. 2018 Jul;5(7):ofy161. https://academic.oup.com/ofid/article/5/7/ofy161/5049601 http://www.ncbi.nlm.nih.gov/pubmed/30046644?tool=bestpractice.com [17]Centers for Disease Control and Prevention. CDC Yellow Book 2026: health information for international travel. Section 5: travel-associated infections & diseases - post-travel diarrhea. Apr 2025 [internet publication]. https://www.cdc.gov/yellow-book/hcp/post-travel-evaluation/post-travel-diarrhea.html
Primary options
paromomycin: children and adults: 25-35 mg/kg/day orally given in 3 divided doses for 5-10 days
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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