Amebic abscess, drugs used

It is used for all types of malaria, for chemotherapy, as well as for non-gastric amebiasis, and amebic abscesses of the liver. Synonyms of this drug are nivaquine, quingamine, delagil, resoquine, atroquine, and others. 

The use of emetine and dehydroemetine is limited to unusual circumstances in which severe amebiasis warrants effective therapy and metronidazole cannot be used. Dehydroemetine is preferred over emetine because of its somewhat better toxicity profile. The drugs should be used to treat amebic dysentery or amebic liver abscess for the minimum period needed to relieve severe symptoms (usually 3-5 days). 

Tissue amebicides (chloroquine, emetines, metronidazole) act on organisms in the bowel wall and the liver luminal amebicides (diloxanide furoate, iodoquinol, paromomycin) act only in the lumen of the bowel. The choice of a drug depends on the form of amebiasis. For asymptomatic disease, diloxanide furoate is the first choice. For mild to severe intestinal infection, metronidazole is used with diloxanide furoate or iodoquinol. The latter regimen, plus chloroquine, is recommended in amebic liver abscess (Table 53-2). The mechanisms of amebicidal action of most drugs in this subclass are unknown. 

Clinical use Metronidazole is the drug of choice in severe intestinal wall disease and in hepatic abscess and other extraintestinal amebic disease. Metronidazole is commonly used with a luminal amebicide. Other important clinical uses of metronidazole include treatment of trichomoniasis, giardiasis, and infections caused by Gardnerella vaginalis and anaerobic bacteria (Bfragilis, C difficile). 

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