Severe invasive amoebiasis

For severe diarrhoea caused by E. histolytica or complicated invasive amoebiasis (eg blood-stained stools, perforation, peritonitis or toxic megacolon), useGonzales, 2019La Hoz, 2019:
1metronidazole 800 mg (child: 15 mg/kg up to 800 mg) orally, 8-hourly for 7 days metronidazole metronidazole metronidazole

OR (if the patient is unable to tolerate oral therapy)

metronidazole 750 mg (child: 15 mg/kg up to 750 mg) intravenously, 8-hourly for 7 days metronidazole metronidazole metronidazole

OR

1tinidazole 2 g (child: 50 mg/kg up to 2 g) orally, daily for 5 days12. For dosage adjustment in adults with kidney impairment, see tinidazole dosage adjustment tinidazole tinidazole tinidazole

FOLLOWED BY (with either of the above drugs)

paromomycin 500 mg (child: 10 mg/kg up to 500 mg) orally, 8-hourly for 7 days3. For dosage adjustment in adults with kidney impairment, see paromomycin dosage adjustment. paromomycin paromomycin paromomycin

Patients with suspected or proven invasive intestinal amoebiasis complicated by peritonitis or toxic megacolon should receive additional antimicrobial therapy for peritonitis. For regimens, see Peritonitis due to perforated viscus; however, use the higher dosage of metronidazole recommended above.

For management of amoebic liver abscess, see Liver abscess.

1 Tinidazole is not registered for use in Australia but is available via the Special Access Scheme.Return
2 Tinidazole is not available as a liquid formulation. If tinidazole dosing is difficult in children, use metronidazole.Return
3 Paromomycin is not registered for use in Australia but is available via the Special Access Scheme.Return