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,a protozoal disease, Amebiasis is most prevalent in tropical and subtropical countries where standards of public hygiene and sanitation may be low.
Symptoms of Amebiasis
Some strains of amebae are harmless but others, for unknown reasons, invade the intestinal wall, causing mucus secretion into the intestines and diarrhea - an illness called amebic dysentery. Additional symptoms may include fever, and abdominal cramping and pain. In severe cases, ulcers may form in the intestinal wall; the amebae gain access to the bloodstream and travel to the liver to form abscesses. The symptoms may appear from a few days to a few months after exposure but usually within two to four weeks.
Diagnosis of Amebiasis
Diagnostic tools may include: • • • • Medical history, physical examination, lab tests, and stool studies Blood tests for revealing antibodies to the organism Sigmoidoscopy to evaluate the intestinal wall Radiological studies including ultrasound and CT (computed tomography) scans to detect liver abscesses
Examination of stools under a microscope is the most common way for a doctor to diagnose amebiasis
Treatment of Amebiasis
The choice of drug depends on the type of clinical presentation and the site of drug action (in the intestinal wall versus inside the intestine itself). Drugs may include metronidazole, paromomycin, iodoquinol, or diloxanide furoate. These drugs have side effects that your physician can discuss with you. Occasionally, it may be necessary to drain a liver abscess. Follow-up care includes stool studies 2 to 4 weeks after completing treatment.
Prevention of Amebiasis
Travelers to countries where sanitary standards are low can reduce their chances of acquiring amebiasis by: • • • • Drinking only water that has been bottled in sanitary conditions or boiled (waterpurifying tablets are ineffective against amebic cysts) Eating only cooked or peeled vegetables or fruits Protecting food from fly contamination Washing hands after defecation and before preparing or eating food
The most important precautions are careful handwashing after each toilet visit and proper disposal of sewage Do not eat or drink milk, cheese, or dairy products that may not have been pasteurized. DRUGS Metronidazole Metronidazole is effective therapy against protozoa such as Trichomonas vaginalis, amebiasis, and giardiasis.anaerobic bacterial infections,in treating Crohn's disease, antibiotic-associated diarrhea, and rosacea It acts selectively aganist anaerobic bacterias as only these bacteria are capabale to reduce it to its active form intracellularly. Reduced it then disrupts DNA's helical structure, thereby inhibiting bacterial nucleic acid synthesis. This eventually results in bacterial cell death. PharmacoKinetics Oral absorption of Metronidazole is found to be 95% . Volume of distribution is found to be 0.76 - 1.02 l/kg and plasma protien binding is 10 %. and metabolism is reported Hepatic. Renal Excretion accounts for 80 % and plasma half life is 7.9 - 9.8 hr. Indications Metronidazole is primarily indicated in conditions like Acute dental infections,
HYPERLINK "Disease.aspx?Code=3305"Acute ulcerative gingivitis, HYPERLINK "Disease.aspx?Code=569"Amoebiasis, HYPERLINK "Disease.aspx? Code=1616"Anaerobic bacterial infection, HYPERLINK "Disease.aspx? Code=3292"Anaerobic infections, HYPERLINK "Disease.aspx?Code=1675"Dysentery, HYPERLINK "Disease.aspx?Code=1052"Giardiasis, HYPERLINK "Disease.aspx? Code=3962"Lung cancer and pancreatic cancer, HYPERLINK "Disease.aspx? Code=1609"Pelvic inflammatory disease, HYPERLINK "Disease.aspx? Code=126"Protozoa infection, HYPERLINK "Disease.aspx?Code=3431"Schizophrenia and other psychoses, HYPERLINK "Disease.aspx?Code=1700"Surgical prophylaxis, HYPERLINK "Disease.aspx?Code=3964"Treatment of locally advanced or metastatic
pancreatic cancer, HYPERLINK "Disease.aspx?Code=1053"Trichomoniasis, HYPERLINK "Disease.aspx?Code=3302"Urogenital trichomoniasis, and can also be given in adjunctive therapy as an alternative drug of choice in
if infection occur, then metronidazole administer with diloxanide furoate. but for prophyloxis, inly metronidazole, 75mg/kg/8hourly/i.v or 500mg/i.v/ 8hourly Contra Indication Metronidazole is contraindicated in conditions like Interaction Metronidazole is known to interact with other drugs like Alprazolam, Carbamazepine,
HYPERLINK "Drug.aspx?intDrug=Cimetidine (HCl)&selection=479%2C173&flag=true&drugCode=479&drugName=Metronidazole& type=13&interactingDrugs=Metronidazole with Cimetidine (HCl)"Cimetidine (HCl), Disulfiram, Disulfiram, Fluorouracil, Nicoumalone, Phenindione, Phenytoin (Na), HYPERLINK "Drug.aspx? intDrug=Podophyllum&selection=479%2C584&flag=true&drugCode=479&drugName =Metronidazole&type=13&interactingDrugs=Metronidazole with Podophyllum"Podophyllum, Ritonavir, Stavudine, Warfarin (Na), Zalcitabine. These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
enzym inducer drugs inc. metabolism thus dec b.a, like phenobarbitol enzyme inhibitor drugs ,prolong the plasma half-life. like cimetidine Side Effects The severe or irreversible adverse effects of Metronidazole, which give rise to further complications include Encephalopathy, Ataxia, Neutropenia, Seizures.
The signs and symptoms that are produced after the acute overdosage of Metronidazole include Disorientation. The symptomatic adverse reactions produced by Metronidazole are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dry mouth, Maculopapular rash, GI upset, Nausea and vomiting, Gynecomastia, Metallic taste, Acute pancreatitis, Darkening of urine.
Inj: 500 mg, 10 mg/ml, Inf: 5 mg/ml, Susp: 200 mg, 200 mg/5ml, Cream: 0.75 %w/w, Gel: 0.75 %w/w, Tabs: 50 mg, 200 mg, 250 mg, 400 mg, 500 mg,
Tabs DS: 400 mg, Vag Tabs: 500 mg,
Inj: 1"5 mg/ml, Susp: 1"75 mg/5ml, 1"100 mg/5ml, 1"200 mg/5ml, 1"250 mg/5ml, 1"321.6 mg/5ml, Tabs: 1"100 mg, 1"200 mg, 1"250 mg, 1"300 mg, 1"400 mg High Risk Group Drug should not be given to Pregnant Mothers, and patients suffering from Liver Malfunction. If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies. Warnings / Precautions Metronidazole should be used with caution in patients with any allergy. Avoid use during pregnancy or lactation. Avoid alcoholic beverages while taking this medication as severe stomach upset, nausea, vomiting, headache and flushing can occur. Storage Condidtions Tab, Susp, Inj : Store Below 40°C. Protect from Sunlight
Diloxanide (Furoate) dichloroacetamide derivative treatment of intestinal amebiasis (dysentery) in combination with other drugs.
Oral absorption of Diloxanide (Furoate) is found to be 2.5% ±2.5. Presystemic metabolism is noted to be 92.5% ±2.5 and metabolism is reported via Intestine. Renal Excretion accounts for rapid and plasma half life is short. Indications Diloxanide (Furoate) is primarily indicated in conditions like Asymptomatic cyst
passers, HYPERLINK "Disease.aspx?Code=2643"Mild amebic dysentery, HYPERLINK "Disease.aspx?Code=2642"Non-dysenteric intestinal amebiasis, HYPERLINK "Disease.aspx?Code=3953"Oliguria due to renal failure, HYPERLINK "Disease.aspx? Code=3953"Oliguria due to renal failure, HYPERLINK "Disease.aspx? Code=115"Parkinsonism
The symptomatic adverse reactions produced by Diloxanide (Furoate) are more or less tolerable and if they become severe, they can be treated symptomatically, these include
Flatulence, Nausea, Vomiting, Anorexia, Diarrhea, Abdominal cramps, Urticaria, Esophagitis, Paresthesias, Albuminuria.
Susp: 1"125 mg/5ml, 1"250 mg/5ml, Tabs: 1"250 mg, 1"500 mg, Dosage
Diloxanide (Furoate) 's dosage details are as follows:
Adult Dosage ( >12 years. )
For 10 Days
Paedriatic Dosage ( 20 Kg. )
Recommended for 512 Yrs of Children
High Risk Group Drug should not be given to Pregnant Mothers, and Neonates. If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies. Warnings / Precautions Diloxanide should be used with caution in patient with symptomatic intestinal amebiasis or extra-intestinal amebiasis, during pregnancy and in childrens less than 2 years of age. Storage Condidtions Tab : Store in a well closed container, Below 40°C. Protect from Sunlight