# Amoebiasis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian MOH Tropical Med 2020 · WHO Parasitic Diseases 2021 - Verified date: 2026-08 ## Verified against - Egyptian MOH Tropical Med 2020 - Amebiasis - disease-level clinical article (amoebiasis-clinical.txt) ## Treatment metadata - Referral & safety-netting (no drug therapy) - Metronidazole — 500 mg — oral.solid - Tinidazole — 500 mg — oral.solid - Nitazoxanide — 500 mg — oral.solid - Diloxanide furoate — 500 mg — oral.solid ## Complete treatment card ```text AMOEBIASIS Sources: Egyptian MOH Tropical Med 2020 · WHO Parasitic Diseases 2021 Review status: REVIEWED against Egyptian MOH Tropical Med 2020, Amebiasis - disease-level clinical article (amoebiasis-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - An amoebic liver abscess usually causes a short history of fever and right-upper-quadrant pain, two to four weeks after exposure [abdominal pain · abscess · fever · right upper quadrant pain] - Fewer than a third of liver-abscess patients have diarrhea at the time of diagnosis [abscess · diarrhoea] - About 10 percent of liver-abscess patients have jaundice, and 5 to 14 percent have chest pain or shortness of breath [abscess · breathlessness · chest pain · jaundice] - A ruptured liver abscess into the chest cavity can cause fever, cough, and respiratory distress [abscess · breathlessness · cough · fever] - A brain abscess is very rare but causes sudden headache, vomiting, and rapidly worsening mental status [abscess · headache · vomiting] SIGNS - what you find (2) - Exam usually finds tenderness over the liver, with an enlarged liver in about half of cases [hepatomegaly] - Rupture into the pericardium can cause signs of pericarditis or cardiac tamponade TESTS (11) - Stool microscopy for trophozoites cannot tell E histolytica apart from nonpathogenic species - Stool PCR has the best sensitivity for telling E histolytica apart from E dispar - Serology is highly sensitive and specific but cannot tell a current infection from a past one - Stool microscopy has poor sensitivity, reported under 60 percent - Stool antigen testing can tell E histolytica from E dispar, with sensitivities up to 88 percent - Stool molecular testing is the gold standard, with 92 to 100 percent sensitivity and 89 to 100 percent specificity - CT can show deep ulceration, patchy involvement, and fat wrapping suggestive of amoebic colitis, but cannot diagnose it alone - Ultrasound is the gold-standard imaging test for a suspected liver abscess - On ultrasound the abscess is usually a single lesion, unlike the typical pyogenic abscess - Gallium scanning can distinguish an amoebic abscess, which appears cold, from a pyogenic one, which appears hot - Colonoscopy with biopsy is not used routinely but can help exclude other diagnoses IF NOT THIS - what else fits (7) - Other dysentery-causing bacteria such as Shigella, E coli, Salmonella, Campylobacter, or C difficile are considered - Other intestinal parasites such as Giardia, Cryptosporidium, Cyclospora, or Schistosoma are considered - Inflammatory bowel disease is a key mimic - Ischemic bowel disease is on the differential - Pyogenic liver abscess is the main differential for an amoebic liver abscess - Echinococcal (hydatid) liver disease is a differential - Hepatic malignancy is on the differential Source StatPearls "Amebiasis" - disease-level clinical article Status traced to the source above !! 2-STEP COURSE - finish each step, then start the next. The steps are not alternatives. !! step 1 Metronidazole or Tinidazole, then step 2 Diloxanide furoate 1. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Amebiasis - disease-level clinical article (amoebiasis-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Fulminant amoebic colitis, peritonitis, toxic megacolon, or bowel perforation requires broad-spectrum antibiotics and urgent surgical evaluation. 2. METRONIDAZOLE [STEP 1 of 2 - CHOOSE ONE] Adult 500-750 mg TID x 7-10 days Peds 35-50 mg/kg/day [child max 2250 mg] (Divided TID for 7-10 days) 3kg -> 105-150 mg/day 4kg -> 140-200 mg/day 5kg -> 175-250 mg/day 6kg -> 210-300 mg/day 7kg -> 245-350 mg/day 8kg -> 280-400 mg/day 9kg -> 315-450 mg/day 10kg -> 350-500 mg/day 11kg -> 385-550 mg/day 12kg -> 420-600 mg/day 13kg -> 455-650 mg/day 14kg -> 490-700 mg/day 15kg -> 525-750 mg/day 16kg -> 560-800 mg/day 17kg -> 595-850 mg/day 18kg -> 630-900 mg/day 19kg -> 665-950 mg/day 20kg -> 700-1000 mg/day 21kg -> 735-1050 mg/day 22kg -> 770-1100 mg/day 23kg -> 805-1150 mg/day 24kg -> 840-1200 mg/day 25kg -> 875-1250 mg/day 26kg -> 910-1300 mg/day 27kg -> 945-1350 mg/day 28kg -> 980-1400 mg/day 29kg -> 1015-1450 mg/day 30kg -> 1050-1500 mg/day 31kg -> 1085-1550 mg/day 32kg -> 1120-1600 mg/day 33kg -> 1155-1650 mg/day 34kg -> 1190-1700 mg/day 35kg -> 1225-1750 mg/day 36kg -> 1260-1800 mg/day 37kg -> 1295-1850 mg/day 38kg -> 1330-1900 mg/day 39kg -> 1365-1950 mg/day 40kg -> 1400-2000 mg/day 41kg -> 1435-2050 mg/day 42kg -> 1470-2100 mg/day 43kg -> 1505-2150 mg/day 44kg -> 1540-2200 mg/day 45kg -> 1575-2250 mg/day 46kg -> 1610-2250 mg/day (upper capped) 47kg -> 1645-2250 mg/day (upper capped) 48kg -> 1680-2250 mg/day (upper capped) 49kg -> 1715-2250 mg/day (upper capped) 50kg -> 1750-2250 mg/day (upper capped) Choice Alternatives WITHIN step 1 of the amoebiasis course - the tissue amoebicide, before the luminal agent. Metronidazole is the standard agent and the cheapest (4-20 EGP); tinidazole's advantage is the shorter course. Source Egyptian MOH Tropical Med 2020 Why Tissue amoebicide that kills invasive Entamoeba histolytica trophozoites in the bowel wall and liver; it does not reliably clear luminal cysts, which is why a luminal amoebicide follows it. Caution Follow with luminal amoebicide to eliminate cysts. Strictly avoid alcohol and propylene glycol-containing products during treatment and for 3 days (72 hours) after the last dose - Egyptian National Drug Formulary, Antimicrobial 2023. Metronidazole causes metallic taste, nausea, and peripheral neuropathy on long use. Egypt DUMOZOL 500MG 20 F.C. TABS. MINA PHARM > ... 7.00 EGP (0.35/unit) ZOLGUARD 500MG 20 TAB. UNIPHARMA CO.... 9.00 EGP (0.45/unit) NITROFECTAZOLE 500 MG 20 F.C. TABS. GYPTO PHARMA 10.50 EGP (0.53/unit) FLAGICURE FORTE 500 MG 20 F.C. TAB KAHIRA 23.00 EGP (1.15/unit) TRICHOGYL 500MG 12 F.C.TAB. EL NASR 15.00 EGP (1.25/unit) FLAGELLAT FORTE 500MG 20 F.C.TABS. MUP 30.00 EGP (1.50/unit) GEDAZOLE 500MG 20 TAB. JEDCO INT. CO... 34.00 EGP (1.70/unit) METROGYPTON 500 MG 20 F.C. TABS. GYPTO PHARMA 34.00 EGP (1.70/unit) DUMOZOL 125MG/5ML SUSP. 125ML MINA PHARM > ... 5.75 EGP -> ? strength differs, ? different route - not oral solid METROZOLE 125MG/5ML SUSP. 120 ML MEMPHIS 19.50 EGP -> ? strength differs, ? different route - not oral solid 3. TINIDAZOLE [STEP 1 of 2 - CHOOSE ONE] Adult 2 g once daily, taken with food x 3 days for intestinal disease, 5 days for a hepatic abscess Peds 50 mg/kg/day [child max 2000 mg] (Once daily for 3-5 days with food) 3kg -> 150 mg/day 4kg -> 200 mg/day 5kg -> 250 mg/day 6kg -> 300 mg/day 7kg -> 350 mg/day 8kg -> 400 mg/day 9kg -> 450 mg/day 10kg -> 500 mg/day 11kg -> 550 mg/day 12kg -> 600 mg/day 13kg -> 650 mg/day 14kg -> 700 mg/day 15kg -> 750 mg/day 16kg -> 800 mg/day 17kg -> 850 mg/day 18kg -> 900 mg/day 19kg -> 950 mg/day 20kg -> 1000 mg/day 21kg -> 1050 mg/day 22kg -> 1100 mg/day 23kg -> 1150 mg/day 24kg -> 1200 mg/day 25kg -> 1250 mg/day 26kg -> 1300 mg/day 27kg -> 1350 mg/day 28kg -> 1400 mg/day 29kg -> 1450 mg/day 30kg -> 1500 mg/day 31kg -> 1550 mg/day 32kg -> 1600 mg/day 33kg -> 1650 mg/day 34kg -> 1700 mg/day 35kg -> 1750 mg/day 36kg -> 1800 mg/day 37kg -> 1850 mg/day 38kg -> 1900 mg/day 39kg -> 1950 mg/day 40kg -> 2000 mg/day 41kg -> 2000 mg/day (capped) 42kg -> 2000 mg/day (capped) 43kg -> 2000 mg/day (capped) 44kg -> 2000 mg/day (capped) 45kg -> 2000 mg/day (capped) 46kg -> 2000 mg/day (capped) 47kg -> 2000 mg/day (capped) 48kg -> 2000 mg/day (capped) 49kg -> 2000 mg/day (capped) 50kg -> 2000 mg/day (capped) Source Egyptian MOH Tropical Med 2020 Why Nitroimidazole tissue amoebicide with the same mechanism as metronidazole against invasive Entamoeba histolytica, favored in Egyptian practice as a shorter, better- tolerated alternative. Caution Tinidazole is shorter in duration and better tolerated than Metronidazole in Egypt. Avoid alcohol during treatment and for 72h after last dose. Take with food to minimize GI distress. Egypt FASIGYN 500 MG 4 TABS. PFIZER 8.35 EGP (2.09/unit) PROTOZOLE 500 MG 12 F.C.TABS. MUP 39.00 EGP (3.25/unit) 4. NITAZOXANIDE [2nd line] Adult 500 mg BID with food x 3 days Peds 1 to 3 years: 100 mg twice daily with food, for 3 days 4 to 11 years: 200 mg twice daily with food, for 3 days (100 mg BID (1-3 yrs), 200 mg BID (4-11 yrs) with food for 3 days) Source Egyptian MOH Tropical Med 2020 Why Broad-spectrum antiparasitic used as a second-line option for mild-to-moderate amoebic colitis when a nitroimidazole is not suitable. Caution Take with food to maximize absorption. May cause bright yellow urine discoloration. Nitazoxanide is an effective alternative for mild-to-moderate amoebic colitis. Egypt UNINITAPROZAX 500MG 12 F.C. TAB. UNIPHARMA CO.... 16.00 EGP (1.33/unit) CRYPTOPER 500MG 30 F.C. TAB. EGPI > TAG PH... 56.00 EGP (1.87/unit) XEROVIRINC 500MG 18 F.C. TAB. MINA PHARM 42.00 EGP (2.33/unit) PARAZOXANIDE 500 MG 18 CAP. MISR > PHARMA... 63.00 EGP (3.50/unit) TRUSTNAL 500 MG 10 F.C. TABS. ADWIA 40.00 EGP (4.00/unit) NIT CLEAN 500MG 12 F.C. TABS. WESTERN PHARM... 72.00 EGP (6.00/unit) CRYPTONAZ 500MG 12 F.C.TAB. COPAD PHARMA 82.00 EGP (6.83/unit) NIT CLEAN 500MG 5*6 F.C. TABS. WESTERN PHARM... 180.00 EGP (30.00/unit) UNINITAPROZAX 100MG/5ML SUSP. 60ML UNIPHARMA CO. > UNIPHARMA 6.00 EGP -> ? strength differs, ? different route - not oral solid ZOLIFUTAL 100MG/5ML SUSP. 60 ML FUTURE PHARMA... 13.50 EGP -> ? strength differs, ? different route - not oral solid 5. DILOXANIDE FUROATE [STEP 2 of 2 - give in order] Adult 500 mg TID x 10 days Peds 20 mg/kg/day [child max 1500 mg] (Given after metronidazole/tinidazole, not in place of it; 20 mg/kg/day divided in 3 doses for 10 days) 3kg -> 60 mg/day 4kg -> 80 mg/day 5kg -> 100 mg/day 6kg -> 120 mg/day 7kg -> 140 mg/day 8kg -> 160 mg/day 9kg -> 180 mg/day 10kg -> 200 mg/day 11kg -> 220 mg/day 12kg -> 240 mg/day 13kg -> 260 mg/day 14kg -> 280 mg/day 15kg -> 300 mg/day 16kg -> 320 mg/day 17kg -> 340 mg/day 18kg -> 360 mg/day 19kg -> 380 mg/day 20kg -> 400 mg/day 21kg -> 420 mg/day 22kg -> 440 mg/day 23kg -> 460 mg/day 24kg -> 480 mg/day 25kg -> 500 mg/day 26kg -> 520 mg/day 27kg -> 540 mg/day 28kg -> 560 mg/day 29kg -> 580 mg/day 30kg -> 600 mg/day 31kg -> 620 mg/day 32kg -> 640 mg/day 33kg -> 660 mg/day 34kg -> 680 mg/day 35kg -> 700 mg/day 36kg -> 720 mg/day 37kg -> 740 mg/day 38kg -> 760 mg/day 39kg -> 780 mg/day 40kg -> 800 mg/day 41kg -> 820 mg/day 42kg -> 840 mg/day 43kg -> 860 mg/day 44kg -> 880 mg/day 45kg -> 900 mg/day 46kg -> 920 mg/day 47kg -> 940 mg/day 48kg -> 960 mg/day 49kg -> 980 mg/day 50kg -> 1000 mg/day Source Egyptian MOH Tropical Med 2020 Why Diloxanide furoate is an add-on to clear luminal cysts after tissue treatment, not an alternative. Caution Diloxanide furoate is an essential luminal amoebicide following tissue treatment (metronidazole/tinidazole) to eradicate cysts. May cause flatulence, abdominal cramps, and nausea. Not recommended in children under 2 years. Egypt AMOEBYL 500MG 20 TABS. MUP 5.30 EGP (0.27/unit) FURAMEBE 500MG 20 TAB. SEDICO 7.70 EGP (0.39/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)