Approach

All Entamoeba histolytica infections should be treated.[1][5][7]​​​ Treatment should be given as soon as the diagnosis is considered, after samples have been taken for testing, as amebiasis is a potentially fatal illness.

Symptomatic patients should initially be given a nitroimidazole (e.g., metronidazole, tinidazole).[7][17]​​​​ Nitroimidazoles have excellent tissue penetration and are active for both luminal and invasive infection. There is no recognized resistance to this class of drug. This should be followed with a luminal agent (e.g., paromomycin) to eradicate gut colonization and prevent relapse.[1][5][7]​​[17]​​​​[33][34]​​​​​​ Adverse effects of these drugs are generally minor, whereas the infection itself is potentially fatal.

Asymptomatic patients also require treatment because of the risk for developing future invasive disease.[1][5] They should be treated with a luminal agent alone.[7]​​[35]​​

Amebic liver abscess

Percutaneous aspiration is not commonly required. It may be required for patients who do not respond to nitroimidazole treatment in 5 to 7 days, or 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]​​​​[36][37]​​​

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