Max 750 mg/dose · Max 2250 mg/day · Duration: 7–10 days · Tissue-active therapy for invasive intestinal or extraintestinal disease — then luminal agent below · i.v. if severe and unable to take oral therapy
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Paromomycin • p.o. • 25–35 mg/kg/day • 3×/day
Duration: 7 days · Luminal eradication — start after completing metronidazole course to clear intestinal cysts
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Tinidazole • p.o. • 50–50 mg/kg/day • 1×/day
Max 2000 mg/day · Duration: 3 days · Intestinal disease · extend to 5 days for extraintestinal disease (liver abscess) · give with food · FDA ≥3 years
• Tinidazole: alternative tissue-active agent — shorter course, often better tolerated than metronidazole; 50 mg/kg/day (max 2 g) × 3 days for intestinal disease, × 5 days for liver abscess (AAP, FDA, Medical Letter).
• Paromomycin alone: asymptomatic cyst passers with confirmed E. histolytica — luminal eradication only; Entamoeba dispar does not require treatment (AAP Red Book, SEIP 2025).
• Iodoquinol or diloxanide furoate: alternative luminal agents when paromomycin unavailable — iodoquinol 30–40 mg/kg/day in 3 doses × 20 days; diloxanide via CDC special access (AAP).
• Large or refractory liver abscess: percutaneous drainage plus medical therapy; chloroquine adjunct rarely in non-responders — consult pediatric ID/GI (AAP, StatPearls).
• WHO 10 mg/kg metronidazole TID × 5 days is for presumptive dysentery when amoebiasis is possible in resource-limited settings — NOT adequate for confirmed invasive disease; use 35–50 mg/kg/day in confirmed E. histolytica (WHO Pocket Book vs AAP).
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Paromomycin • p.o. • 25–35 mg/kg/day • 3×/day
Duration: 7 days · Luminal eradication — start after completing tinidazole course
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Clinical notes
• Treat invasive amoebiasis (intestinal or extraintestinal) with a tissue-active nitroimidazole (metronidazole or tinidazole) followed by a luminal agent — two-step therapy is required (AAP Red Book, CDC, WHO).
• Do not use metronidazole or tinidazole alone without subsequent luminal eradication therapy — monotherapy leaves intestinal cysts and risks relapse (AAP, StatPearls).
• Asymptomatic cyst passage with confirmed E. histolytica: luminal agent only (paromomycin, iodoquinol, or diloxanide) — no tissue-active drug needed (AAP, SEIP 2025).
• Evaluate for amoebic liver abscess if fever, right upper quadrant pain, hepatomegaly, or persistent systemic symptoms — abdominal ultrasound or CT and specialist referral (AAP, CDC).
• Confirm E. histolytica with species-specific testing — nonpathogenic Entamoeba species do not require treatment; distinguish from E. dispar by PCR or antigen testing (ESPGHAN/ESPID, SEIP 2025).
• AAP Red Book — Amebiasis (2024)
• WHO Pocket Book of Hospital Care for Children — Diarrhoea (amebiasis) (2022)
