Dientamoebiasis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: : Kalsang Dolma, M.B.B.S.[2]

Medical Therapy

Antimicrobial Regimen

• Dientamoebiasis

• Preferred regimen: Iodoquinol 650 mg PO tid for 20 days
• Alternative regimen (1): Tetracycline 500 mg PO qid for 10 days
• Alternative regimen (2): Metronidazole 500–750 mg PO tid for 10 days
• Alternative regimen (3): Paromomycin 25–35 mg/kg/day PO in three divided doses for 7 days

• 1.1 Treatment in pregnancy

• The use of Iodoquinol in pregnancy is limited, and risk to the embryo-fetus is unknown, should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
• Metronidazole is in pregnancy category B. Data on the use of this drug in pregnant women are conflicting. The available evidence suggests use during pregnancy has a low risk of congenital anomalies. May be used during pregnancy in those patients who will clearly benefit from the drug, although its use in the first trimester is generally not advised.
• Oral dose of Paromomycin generally is poorly absorbed from the gastrointestinal tract, with minimal, if any, systemic availability.

• 1.2 Treatment during lactation

• Iodoquinol should be used with caution in breastfeeding women.
• Metronidazole should be used during lactation only if the potential benefit of therapy to the mother justifies the potential risk to the infant.
• Oral dose of Paromomycin is unlikely to be excreted in breast milk, and the drug generally is poorly absorbed from the gastrointestinal tract.

• 1.3 Treatment in pediatric patients

• Iodoquinol 30–40 mg/kg/day (maximum 2 g) PO in 3 doses for 􏰄20 days. The safety of iodoquinol in children has not been established.
• Tetracycline 40 mg/kg/day (maximum 2 g) PO in 4 doses for􏰄 10 days
• Metronidazole 35–50 mg/kg/day PO in 3 doses for􏰄 10 days. The safety in children has not been established, is listed as an antiamebic and antigiardiasis medicine on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.
• Paromomycin 25–35 mg/kg/day PO in 3 doses􏰄 for 7 days. The safety of oral dose in children has not been formally evaluated. However, the safety profiles likely are comparable in children and adults.