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# Diloxanide Furoate
## Overview
Diloxanide furoate is a luminal amebicide that acts locally in the gastrointestinal tract to kill *Entamoeba histolytica* trophozoites and cysts. It is poorly absorbed systemically and is ineffective against extraintestinal (e.g., hepatic) amebiasis.
## Primary Indications
* Treatment of asymptomatic *E. histolytica* (cyst passers).
* Follow-up therapy after treatment of symptomatic invasive amebiasis with a tissue amebicide (e.g., metronidazole or tinidazole) to eliminate remaining luminal cysts.
## Adult Dosing
* 500 mg orally three times daily for 10 days.
## Pediatric Dosing
* 20 mg/kg/day orally, divided into three doses for 10 days.
* *Note:* Maximum daily dose is 1500 mg.
## Dose Adjustments
* **Renal/Hepatic:** No specific dose adjustments established; limited systemic absorption makes significant accumulation unlikely. Use caution in severe hepatic impairment, though data is sparse.
## Contraindications
* Known hypersensitivity to diloxanide furoate.
## Adverse Effects
* **Common:** Flatulence (frequently reported), nausea, vomiting, abdominal cramps, and diarrhea.
* **Rare:** Urticaria, pruritus, and rarely anaphylaxis.
## Key Drug Interactions
* Clinically significant drug-drug interactions are minimal due to low systemic bioavailability.
## Monitoring
* Monitor for resolution of gastrointestinal symptoms.
* Stool examinations for *E. histolytica* cysts should be repeated 2–4 weeks after completion of therapy to confirm eradication.
## Clinical Pearls
* **Not for systemic disease:** Must never be used alone to treat invasive amebiasis (e.g., amebic liver abscess); it will not reach therapeutic concentrations in tissues.
* **Administration:** Administer with or after meals to minimize gastrointestinal upset.
* **Access:** In many regions, diloxanide furoate is not commercially available and must be procured via specialized import protocols (e.g., CDC Drug Service in the USA).
* **Alternative:** Paromomycin is a commonly used alternative luminal agent if diloxanide is unavailable.
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*Disclaimer: Clinical practice guidelines vary by region. Always verify specific dosing, local availability, and contraindications against institutional protocols and the most recent product monograph before prescribing.*
