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Learning objective

you should be able to:

List the major group of antiamebiasis Choose the drug for asymptomatic, and

symptomatic amebiasis Identify the drugs useful in amebic liver abscess Identify side effects of antiamebiasis List the clinical aplication of metronidazole

case
A female patient complain lower abdominal
discomfort, flatulence, diarrhea. Patient is diagnosed as symptomatic amebiasis. E.histolytica is identified in her stool. The doctor prescribe an oral drug, which reduces her intestinal symptom. Later she got a severe dysentry, fever, weight loss and enlarge liver. Diagnosis now, amebic liver abscess. She has a history of disrrythmia. How do you manage this patient ?

Amebiasis occurs in two forms


Bowel lumen amebiasis/asymptomatic amebiasis
treated by lumen amebicides: diloxanide furoate iodoquinol tetracycline paromomycin Tissue invading amebiasis/symptomatic dysentery & hepatic amebiasis, treated by tissue amebicides: metronidazole emetine & dihydroemetine chloroquine always combined with luminal amebicides

Diloxanide Furoate
Useful in eradicating the bowel lumen dwelling

form 90% is rapidly absorbed and conyugated to form the glucuronide, promptly excreted in the urine Converted in the gut to diloxanide freebase The commonest adverse effect is flatulence

Iodoquinol
Diiodohydroxyquinoline & clioquinol 90% retained in the intestine Less effective than diloxanide Adverse effect:
g.i.symptom thyroid enlargement neurotoxic effect (SMON)

Tetracycline
Indirectly amebicide by modifying the
intestinal flora which necessary for ameba to survive

Paromomycine
Aminoglycoside antibiotic Direct amebicidal action

Chloroquine
Effective only in hepatic amebiasis (high
concentration in liver) Less effective than emetine Should be given in combination with emetine or metronidazole

Emetine & dihydroemetine


Equally effective with metronidazole But more toxic Administered parenterally, accumulate in

tissue, eliminated slowly via kidney Toxic to the myocardium (arrhythmia and congestive heart failure) Should not be used in patient cardiac or renal disease, elderly, young children, pregnancy

Metronidazole
Has potent amebicidal activity Orally active Eradicate tissue infection The drug of first choice in tissue amebiasis Adverse effects:
g.i tract irritation disulfiram like reaction (with alcohol) coumarin effect increase dark coloration of urine

Summary
Two major group of antiamebiasis: luminal
amebicides, tissue amebicides For asymptomatis: diloxanide furoate For symptomatis: metronidazole Drugs useful in amebic liver abscess: metronidazole, emetin, chloroquine. Should be followed by lumen amebicide Clinical aplication of Metronidazole: intestinal and extraintestinal wall amebiasis, trichomonas, giardiasis, anaerobic bacteria