Treatment for A person with asymptomatic intestinal disease who is passing cysts in stool: Treat with luminals: Paromomycin (perferred) or Iodoquinol.
Treatment for a person with mild to severe intestinal intestinal infection (diarrhea or dysentary) treat with luminal and tissue amebicides. (Paromomycin or Iodoquinol) and (Metronidazole or Tinidazole)
Treatment for a person with extra-intestinal infection (hepatic abscess) treat with luminal (paromomycin or iodoquinol) and tissue amebicides (metronidazole or tinidazole) and if resistant chloroquine.
Treatment for a person with extra-intestinal infection non hepatic: treat with luminal (paromomycin or iodoquinol) and tissue amebicides (metronidazole or tinidazole).
Paromomycin and Iodoquinol Luminal Amebicides
Paromomycin inhibits protein synthesis, Side effects mild: Diarrhea, nausea, contraindicated if there is bowel perforation: nephrotoxic, ototoxic
Iodoquinol Not well absorbed in the intestine, unknown MOA, Contraindication in iodine intolerant patients
Metronidazole and Tinidazole Tissue amebicides, Target intracellular targets like DNA
Systemic Amebicides Dehydroemetine, Tetracycline, and Chloroquine.
Tetracycline For bowel wall only. MOA: acts by altering the GI flora needed for amebic proliferation, contraindicated in children and pregnant women.
Chloroquine Used to treat amebic liver abscesses, if resistant to tissue amebicides
Dehydroemetine given IM not IV or orally, side effects cardiotoxic and hypotension
Drugs to treat Giardia Lamblia Metronidazole, Tinidazole, Furazolidine, Nitazoxanide
Drugs to treat Cryptosporidium Parvus Nitazoxanide and Paromomycin
Alternative to metro for Giardia, MOA like metro, Side Effects: Disulfram like effects, Inhibits monoamine-oxidase (breaks down sympathetic neurotransmitters) can cause hypertensive crisis with sympathomimetics. Furazolidine
Nitazoxanide : Inhibits pyruvate:ferredoxin oxidoreductase (PFOR) which is necessary for anaerobic energy metabolism
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