Amebicide
Encyclopedia
An amebicide is an agent used in the treatment of amoebozoa
Amoebozoa
The Amoebozoa are a major group of amoeboid protozoa, including the majority that move by means ofinternal cytoplasmic flow. Their pseudopodia are characteristically blunt and finger-like,...

 infections.
Among these agents are the following, linked to the infections they are used to treat:

Although Naegleria
Naegleria
Naegleria is a eukaryotic genus. The genus was named after French zoologist Mathieu Naegler.Species include:* Naegleria fowleri, which causes a rare and generally fatal disease in humans* Naegleria gruberi-External links:...

is sometimes considered amoeboid
Amoeboid
Amoeboids are single-celled life-forms characterized by an irregular shape."Amoeboid" and "amœba" are often used interchangeably even by biologists, and especially refer to a creature moving by using pseudopodia. Most references to "amoebas" or "amoebae" are to amoeboids in general rather than to...

, it is not closely related to the Amoebozoa (it is much more closely related to Trypanosoma
Trypanosoma
Trypanosoma is a genus of kinetoplastids , a monophyletic group of unicellular parasitic flagellate protozoa. The name is derived from the Greek trypano and soma because of their corkscrew-like motion. All trypanosomes are heteroxenous and are transmitted via a vector...

), and agents used to treat Naegleria infections (such as Amphotericin B
Amphotericin B
Amphotericin B is a polyene antifungal drug, often used intravenously for systemic fungal infections...

) are usually addressed separately.

Entamoeba

  • Metronidazole
    Metronidazole
    Metronidazole is a nitroimidazole antibiotic medication used particularly for anaerobic bacteria and protozoa. Metronidazole is an antibiotic, amebicide, and antiprotozoal....

    , or a related drug such as Tinidazole
    Tinidazole
    Tinidazole is an anti-parasitic drug used against protozoan infections. It is widely known throughout Europe and the developing world as treatment for a variety of amoebic and parasitic infections...

    , Secnidazole
    Secnidazole
    Secnidazole is a nitroimidazole anti-infective. Effectiveness in the treatment of dientamoebiasis has been reported. It has also been tested against Atopobium vaginae....

     or Ornidazole
    Ornidazole
    Ornidazole is a drug that cures some protozoan infections. It is used by the poultry industry.It has been investigated for use in Crohn's disease after bowel resection.-References:...

    , is used to destroy amoebae that have invaded tissue.
  • Several drugs are available for treating intestinal infections, the most effective of which has been shown to be Paromomycin (also known as Humatin).


E. histolytica infections occur in both the intestine and (in people with symptoms) in tissue of the intestine and/or liver. As a result, both tissue and lumenal drugs are needed to treat the infection, one for each location. Metronidazole is usually being given first, followed by Paromomycin or Diloxanide.

E. dispar does not require treatment, but many laboratories (even in the developed world) do not have the facilities to distinguish this from E. histolytica.

Tissue amebicides

Metronidazole
Metronidazole
Metronidazole is a nitroimidazole antibiotic medication used particularly for anaerobic bacteria and protozoa. Metronidazole is an antibiotic, amebicide, and antiprotozoal....

, or a related drug such as tinidazole
Tinidazole
Tinidazole is an anti-parasitic drug used against protozoan infections. It is widely known throughout Europe and the developing world as treatment for a variety of amoebic and parasitic infections...

, secnidazole
Secnidazole
Secnidazole is a nitroimidazole anti-infective. Effectiveness in the treatment of dientamoebiasis has been reported. It has also been tested against Atopobium vaginae....

 or ornidazole
Ornidazole
Ornidazole is a drug that cures some protozoan infections. It is used by the poultry industry.It has been investigated for use in Crohn's disease after bowel resection.-References:...

, is used to destroy amoebae that have invaded tissue. These are rapidly absorbed into the bloodstream and transported to the site of infection. Because they are rapidly absorbed there is almost none remaining in the intestine.

For amebic dysentery a multi-prong approach must be used, starting with one of:
  • metronidazole
    Metronidazole
    Metronidazole is a nitroimidazole antibiotic medication used particularly for anaerobic bacteria and protozoa. Metronidazole is an antibiotic, amebicide, and antiprotozoal....

     500–750 mg three times a day for 5–10 days
  • tinidazole
    Tinidazole
    Tinidazole is an anti-parasitic drug used against protozoan infections. It is widely known throughout Europe and the developing world as treatment for a variety of amoebic and parasitic infections...

     2g once a day for 3 days is an alternative to metronidazole


Doses for children are calculated by body weight and a pharmacist should be consulted for help.

Luminal amebicides

Since most of the amoebae remain in the intestine when tissue invasion occurs, it is important to get rid of those also or the patient will be at risk of developing another case of invasive di effective of which has been shown to be paromomycin (also known as Humatin); iodoquinol (also known as Yodoxin) is used in the US; and diloxanide furoate
Diloxanide furoate
Diloxanide furoate is an anti-protozoal drug used in the treatment of Entamoeba histolytica and some other protozoal infections.-Safety and effectiveness:...

 (also known as Furamide) is used in certain other countries.

In addition to the tissue amebicides above, one of the following luminal amebicides should be prescribed as an adjunctive treatment, either concurrently or sequentially, to destroy E. histolytica in the colon:
  • Paromomycin 500 mg three times a day for 10 da
  • Iodoquinol 650 mg three times a day for 20 days


Doses for children are calculated by body weight and a pharmacist should be consulted for help.

For amebic liver abscess

For amebic liver abscess:
  • Metronidazole 400 mg three times a day for 10 days
  • Tinidazole 2g once a day for 6 days is an alternative to metronidazole
  • Diloxanide furoate 500 mg three times a day for 10 days (or one of the other lumenal amebicides above) must always be given afterwards


Doses for children are calculated by body weight and a pharmacist should be consulted for help.

Acanthamoeba

Propamidine isethionate has been used in the treatment of Acanthamoeba
Acanthamoeba
Acanthamoeba is a genus of amoebae, one of the most common protozoa in soil, and also frequently found in fresh water and other habitats. The cells are small, usually 15 to 35 μm in length and oval to triangular in shape when moving. The pseudopods form a clear hemispherical lobe at the anterior,...

infection.
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