Approach

All Entamoeba histolytica infections should be treated.[1][5]​ Treatment should be given as soon as the diagnosis is considered, after samples have been taken for testing, as amebiasis is a potentially fatal illness.

Symptomatic patients should initially be given a nitroimidazole (metronidazole or tinidazole). Nitroimidazoles have excellent tissue penetration and are active for both luminal and invasive infection. There is no recognized resistance to this class of antiamebic medication. This should be followed with a luminal agent (such as paromomycin or diloxanide) to eradicate gut colonization and prevent relapse.[1][5][9]​​[31][32][33]​​​​ For most of these medicines, adverse effects are generally minor, whereas the infection itself is potentially fatal.

Asymptomatic patients also require treatment because of the risk for developing future invasive disease.[1][5] They should be treated with a luminal agent alone.[33]​[34]​​

Amebic liver abscess

Percutaneous aspiration is not commonly required. It may be required for patients who do not respond to nitroimidazole treatment in 5 to 7 days, or with large (>5 cm diameter) or left lobe lesions. In patients with large abscesses, draining the abscess in addition to treating with metronidazole or tinidazole could aid in the early resolution of pain and tenderness.[1][2][5][9]​​[35][36]​​

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