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Amoebic colitis insufficient to metronidazole monotherapy
Ryosuke Ikeda1, Hiroaki Kaneko2, Hiroki Sato2
1Department of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. ryosuke@yokohama-cu.ac.jp.
Clinical Journal of Gastroenterology
|December 12, 2024
Summary
Metronidazole monotherapy may be insufficient for amoebic colitis due to residual cysts. Combination therapy with paromomycin offers an effective treatment for persistent ulcerative lesions.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Parasitology
Background:
- Amoebic colitis, caused by Entamoeba histolytica, is a significant parasitic gastrointestinal disease.
- Metronidazole monotherapy is a common treatment in Japan, often proving effective.
- Treatment failure can occur, particularly in cases involving residual cysts.
Purpose of the Study:
- To report a case of metronidazole-insufficient amoebic colitis.
- To investigate the efficacy of combination therapy for persistent amoebic colitis.
Main Methods:
- A case study of a 73-year-old man with a history of residing in Southeast Asia.
- Initial treatment with metronidazole monotherapy.
- Subsequent colonoscopies, diagnosis of metronidazole-insufficient amoebic colitis, and treatment with combined metronidazole and paromomycin.
Main Results:
- Initial metronidazole monotherapy failed to resolve ulcerative lesions in the cecum.
- Combined therapy with metronidazole and paromomycin for 10 days led to the resolution of ulcerative lesions.
- One year post-treatment, no ulcerative lesions were observed, indicating successful eradication.
Conclusions:
- Metronidazole-insufficient amoebic colitis should be considered when ulcerative lesions persist after metronidazole administration.
- Paromomycin demonstrates efficacy against residual amoebic cysts.
- A combination therapy of paromomycin with metronidazole is proposed for managing persistent amoebic colitis.
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