Dawaa Reference

infectious

Amoebiasis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Egyptian MOH Tropical Med 2020 · WHO Parasitic Diseases 2021

Verified against2 documents
  • Egyptian MOH Tropical Med 2020
  • Amebiasis - disease-level clinical article (amoebiasis-clinical.txt)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Amebiasis" - disease-level clinical article

Presentation findings are traced to the source above.

Combination safety

Combination regimens

!! 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
Dose 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.

Cautions
  • RED FLAG - Fulminant amoebic colitis, peritonitis, toxic megacolon, or bowel perforation requires broad-spectrum antibiotics and urgent surgical evaluation.
2

METRONIDAZOLE

Regimen: amoebiasis-course

STEP 1 of 2 - CHOOSE ONE

Strength500 mg

Formoral.solid

Adult dose and duration

500-750 mg TID x 7-10 days

Paediatric dose

35-50 mg/kg/day [child max 2250 mg] (Divided TID for 7-10 days)

Dose by weight
3kg105-150 mg/day
4kg140-200 mg/day
5kg175-250 mg/day
6kg210-300 mg/day
7kg245-350 mg/day
8kg280-400 mg/day
9kg315-450 mg/day
10kg350-500 mg/day
11kg385-550 mg/day
12kg420-600 mg/day
13kg455-650 mg/day
14kg490-700 mg/day
15kg525-750 mg/day
16kg560-800 mg/day
17kg595-850 mg/day
18kg630-900 mg/day
19kg665-950 mg/day
20kg700-1000 mg/day
21kg735-1050 mg/day
22kg770-1100 mg/day
23kg805-1150 mg/day
24kg840-1200 mg/day
25kg875-1250 mg/day
26kg910-1300 mg/day
27kg945-1350 mg/day
28kg980-1400 mg/day
29kg1015-1450 mg/day
30kg1050-1500 mg/day
31kg1085-1550 mg/day
32kg1120-1600 mg/day
33kg1155-1650 mg/day
34kg1190-1700 mg/day
35kg1225-1750 mg/day
36kg1260-1800 mg/day
37kg1295-1850 mg/day
38kg1330-1900 mg/day
39kg1365-1950 mg/day
40kg1400-2000 mg/day
41kg1435-2050 mg/day
42kg1470-2100 mg/day
43kg1505-2150 mg/day
44kg1540-2200 mg/day
45kg1575-2250 mg/day
46kg1610-2250 mg/day (upper capped)
47kg1645-2250 mg/day (upper capped)
48kg1680-2250 mg/day (upper capped)
49kg1715-2250 mg/day (upper capped)
50kg1750-2250 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.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
DUMOZOL 500MG 20 F.C. TABS.MINA PHARM > ALPHARMA-DENMARK7.00 EGP (0.35/unit)
ZOLGUARD 500MG 20 TAB.UNIPHARMA CO. > UNIPHARMA9.00 EGP (0.45/unit)
NITROFECTAZOLE 500 MG 20 F.C. TABS.GYPTO PHARMA10.50 EGP (0.53/unit)
FLAGICURE FORTE 500 MG 20 F.C. TABKAHIRA23.00 EGP (1.15/unit)
TRICHOGYL 500MG 12 F.C.TAB.EL NASR15.00 EGP (1.25/unit)
FLAGELLAT FORTE 500MG 20 F.C.TABS.MUP30.00 EGP (1.50/unit)
GEDAZOLE 500MG 20 TAB.JEDCO INT. CO. FOR PHARMACEUTICALS34.00 EGP (1.70/unit)
METROGYPTON 500 MG 20 F.C. TABS.GYPTO PHARMA34.00 EGP (1.70/unit)
DUMOZOL 125MG/5ML SUSP. 125ML? strength differs? different route - not oral solidMINA PHARM > ALPHARMA-DENMARK5.75 EGP
METROZOLE 125MG/5ML SUSP. 120 ML? strength differs? different route - not oral solidMEMPHIS19.50 EGP
3

TINIDAZOLE

Regimen: amoebiasis-course

STEP 1 of 2 - CHOOSE ONE

Strength500 mg

Formoral.solid

Adult dose and duration

2 g once daily, taken with food x 3 days for intestinal disease, 5 days for a hepatic abscess

Paediatric dose

50 mg/kg/day [child max 2000 mg]

(Once daily for 3-5 days with food)

Dose by weight
3kg150 mg/day
4kg200 mg/day
5kg250 mg/day
6kg300 mg/day
7kg350 mg/day
8kg400 mg/day
9kg450 mg/day
10kg500 mg/day
11kg550 mg/day
12kg600 mg/day
13kg650 mg/day
14kg700 mg/day
15kg750 mg/day
16kg800 mg/day
17kg850 mg/day
18kg900 mg/day
19kg950 mg/day
20kg1000 mg/day
21kg1050 mg/day
22kg1100 mg/day
23kg1150 mg/day
24kg1200 mg/day
25kg1250 mg/day
26kg1300 mg/day
27kg1350 mg/day
28kg1400 mg/day
29kg1450 mg/day
30kg1500 mg/day
31kg1550 mg/day
32kg1600 mg/day
33kg1650 mg/day
34kg1700 mg/day
35kg1750 mg/day
36kg1800 mg/day
37kg1850 mg/day
38kg1900 mg/day
39kg1950 mg/day
40kg2000 mg/day
41kg2000 mg/day (capped)
42kg2000 mg/day (capped)
43kg2000 mg/day (capped)
44kg2000 mg/day (capped)
45kg2000 mg/day (capped)
46kg2000 mg/day (capped)
47kg2000 mg/day (capped)
48kg2000 mg/day (capped)
49kg2000 mg/day (capped)
50kg2000 mg/day (capped)
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
FASIGYN 500 MG 4 TABS.PFIZER8.35 EGP (2.09/unit)
PROTOZOLE 500 MG 12 F.C.TABS.MUP39.00 EGP (3.25/unit)
4

NITAZOXANIDE

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg BID with food x 3 days

Paediatric dose

(100 mg BID (1-3 yrs), 200 mg BID (4-11 yrs) with food for 3 days)

Dose by age
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
Dose 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.

Cautions
  • Take with food to maximize absorption.
  • May cause bright yellow urine discoloration.
  • Nitazoxanide is an effective alternative for mild-to-moderate amoebic colitis.
Egyptian brands
Egyptian brandManufacturerIndicative price
UNINITAPROZAX 500MG 12 F.C. TAB.UNIPHARMA CO. > UNIPHARMA16.00 EGP (1.33/unit)
CRYPTOPER 500MG 30 F.C. TAB.EGPI > TAG PHARMA56.00 EGP (1.87/unit)
XEROVIRINC 500MG 18 F.C. TAB.MINA PHARM42.00 EGP (2.33/unit)
PARAZOXANIDE 500 MG 18 CAP.MISR > PHARMACARE63.00 EGP (3.50/unit)
TRUSTNAL 500 MG 10 F.C. TABS.ADWIA40.00 EGP (4.00/unit)
NIT CLEAN 500MG 12 F.C. TABS.WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA72.00 EGP (6.00/unit)
CRYPTONAZ 500MG 12 F.C.TAB.COPAD PHARMA82.00 EGP (6.83/unit)
NIT CLEAN 500MG 5*6 F.C. TABS.WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA180.00 EGP (30.00/unit)
UNINITAPROZAX 100MG/5ML SUSP. 60ML? strength differs? different route - not oral solidUNIPHARMA CO. > UNIPHARMA6.00 EGP
ZOLIFUTAL 100MG/5ML SUSP. 60 ML? strength differs? different route - not oral solidFUTURE PHARMACEUTICAL INDUSTRIES (FPI)13.50 EGP
5

DILOXANIDE FUROATE

Regimen: amoebiasis-course

STEP 2 of 2 - give in order

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg TID x 10 days

Paediatric dose

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)

Dose by weight
3kg60 mg/day
4kg80 mg/day
5kg100 mg/day
6kg120 mg/day
7kg140 mg/day
8kg160 mg/day
9kg180 mg/day
10kg200 mg/day
11kg220 mg/day
12kg240 mg/day
13kg260 mg/day
14kg280 mg/day
15kg300 mg/day
16kg320 mg/day
17kg340 mg/day
18kg360 mg/day
19kg380 mg/day
20kg400 mg/day
21kg420 mg/day
22kg440 mg/day
23kg460 mg/day
24kg480 mg/day
25kg500 mg/day
26kg520 mg/day
27kg540 mg/day
28kg560 mg/day
29kg580 mg/day
30kg600 mg/day
31kg620 mg/day
32kg640 mg/day
33kg660 mg/day
34kg680 mg/day
35kg700 mg/day
36kg720 mg/day
37kg740 mg/day
38kg760 mg/day
39kg780 mg/day
40kg800 mg/day
41kg820 mg/day
42kg840 mg/day
43kg860 mg/day
44kg880 mg/day
45kg900 mg/day
46kg920 mg/day
47kg940 mg/day
48kg960 mg/day
49kg980 mg/day
50kg1000 mg/day
Dose source

Egyptian MOH Tropical Med 2020

Why

Diloxanide furoate is an add-on to clear luminal cysts after tissue treatment, not an alternative.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
AMOEBYL 500MG 20 TABS.MUP5.30 EGP (0.27/unit)
FURAMEBE 500MG 20 TAB.SEDICO7.70 EGP (0.39/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.