Amoebiasis (also called amoebic dysentery) is an intestinal infection caused by a parasite called Entamoeba histolytica. It can cause diarrhoea, abdominal pain, bloody stools, and, in severe cases, liver abscesses.

Several medicines used to treat amoebiasis. The appropriate medicine depends on whether the infection is limited to the intestines, is causing invasive disease, or is present without symptoms.

Important: The standard treatment for confirmed invasive amoebiasis usually involves two stages: a medicine that kills parasites invading the intestinal tissues, followed by another medicine that clears parasites remaining inside the intestine.

1. Medicines used to treat amoebiasis

The following medicines are used in clinical treatment.

Flagyl 400mg Tablet (Metronidazole) x100 | MedeCify

1. Metronidazole

Common treatment

• Brand examples: Flagyl and generic metronidazole.
• Used for intestinal amoebiasis and amoebic liver abscess.
• A Nigerian prescribing reference lists 800 mg three times daily for 5 days for adult amoebic dysentery. Liver abscess requires a different, longer regimen. Prescribing Companion+1

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2. Tinidazole

• Alternative to metronidazole.
• Used to treat invasive intestinal amoebiasis.
• Prescribing reference lists 2 g once daily for 3 days for adult amoebic dysentery. Prescribing Companion+1

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3. Diloxanide furoate

Important follow-up treatment

• Acts inside the intestine to eliminate remaining amoebae.
• Often prescribed after metronidazole or tinidazole for symptomatic invasive amoebiasis.
• Nigerian reference adult regimen: 500 mg three times daily for 10 days. Prescribing Companion+1

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4. Paromomycin

• A luminal amoebicide that acts inside the intestine.
• Can be used after metronidazole or tinidazole.
• An alternative when diloxanide furoate is unsuitable or unavailable. NCBI Bookshelf+1

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5. Iodoquinol

• Another medicine that acts inside the intestine.
• Used as an alternative luminal amoebicide.
• Availability may vary between Nigerian pharmacies. NCBI Bookshelf+1

2. Common treatment combinations

For confirmed symptomatic amoebiasis, treatment generally follows this pattern:

First medicine	Follow-up medicine
Metronidazole	Diloxanide furoate
Metronidazole	Paromomycin
Tinidazole	Diloxanide furoate
Tinidazole	Paromomycin

The first medicine treats the parasites invading body tissues. The second eliminates parasites remaining in the intestinal cavity.

Why is the second medicine important?

Taking metronidazole alone may improve symptoms without completely eliminating intestinal amoebae. This can result in persistent infection or recurrence. The additional luminal medicine helps eradicate the remaining infection. NCBI Bookshelf+2

3. Supportive treatment

In addition to antiparasitic medicines:

• ORS (Oral Rehydration Salts): Replaces water and electrolytes lost through diarrhoea.
• Adequate fluids: Helps prevent dehydration.
• Appropriate nutrition: Continue eating tolerable, nutritious meals.
• Zinc: May be recommended for children with diarrhoea, according to age-specific clinical guidance.

Do not use loperamide or other medicines that stop bowel movements without medical advice if there is bloody diarrhoea or fever.

4. Important precautions

• Avoid alcohol while taking metronidazole and follow the medicine’s instructions about when it is safe to resume drinking.
• Pregnant women, particularly during the first trimester, should not self-medicate with metronidazole.
• Children require weight-based doses.
• People with liver disease or other significant medical conditions need individual assessment.
• Do not combine metronidazole and tinidazole without a specific medical indication.

5. Tests recommended before treatment

Not every case of diarrhoea or abdominal discomfort is caused by amoebiasis. Other infections, including bacterial dysentery and giardiasis, can produce similar symptoms.

Recommended investigations include:

1. Stool microscopy: Checks for amoebic cysts and trophozoites.
2. Stool antigen test: Helps identify Entamoeba histolytica.
3. Stool PCR: Can distinguish disease-causing E. histolytica from non-pathogenic species such as E. dispar.
4. Abdominal ultrasound: May be required if an amoebic liver abscess is suspected.

A positive report showing only amoebic cysts does not always establish active invasive amoebiasis. CDC+1

6. When to seek urgent medical attention

Visit a hospital promptly if you experience:

• Bloody diarrhoea.
• Severe or persistent abdominal pain.
• High fever.
• Repeated vomiting or inability to drink.
• Signs of dehydration, such as reduced urination, dizziness or extreme weakness.
• Pain in the upper right abdomen, especially with fever.
• Yellowing of the eyes or skin.

These symptoms may indicate severe intestinal infection, dehydration or an amoebic liver abscess.

7. References

The following resources provide further treatment information:

• CDC – Amoebiasis: Diagnosis and Treatment.
• Médecins Sans Frontières – Amoebiasis Treatment Guidelines.

8. Important information to determine the appropriate medicine

The correct treatment depends on the patient’s age, symptoms and laboratory results.