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# Diloxanide Furoate
## Overview
Diloxanide furoate is a luminal amebicide used to eliminate *Entamoeba histolytica* cysts from the gastrointestinal tract. It is poorly absorbed systemically and acts primarily within the bowel lumen. It is frequently categorized as a secondary treatment used in conjunction with a systemic tissue amebicide (e.g., metronidazole).
## Primary Indications
Treatment of asymptomatic intestinal colonization (*E. histolytica* cyst passers) and follow-up therapy for symptomatic amebiasis after the eradication of invasive tissue forms.
## 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: Consult local protocols or institutional infectious disease guidelines regarding age/weight-based truncations.*
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific adjustment guidelines exist due to minimal systemic absorption; however, caution is advised in severe hepatic impairment where metabolism might be altered.
## Contraindications
Hypersensitivity to diloxanide furoate or any component of the formulation.
## Adverse Effects
* **Gastrointestinal:** Flatulence (highly common), abdominal cramps, nausea, vomiting, and diarrhea.
* **Dermatological:** Pruritus/urticaria (rare).
* **Neurological:** Occasional reports of diplopia or dizziness.
## Key Drug Interactions
There are no major clinically significant pharmacokinetic drug interactions due to the drug’s limited systemic bioavailability.
## Monitoring
* **Efficacy:** Stool microscopy for *E. histolytica* cysts should be performed after completing therapy to ensure clearance.
* **GI Symptoms:** Monitor for persistence or exacerbation of abdominal symptoms, which may indicate treatment failure or alternative etiology.
## Clinical Pearls
* **Not for Invasive Disease:** Diloxanide furoate is ineffective against extra-intestinal amebiasis (e.g., liver abscess). It must be paired with tissue-active agents like metronidazole or tinidazole for patients with symptomatic invasive disease.
* **Administration:** Administer with meals to reduce gastrointestinal irritation.
* **Availability:** In many regions, this drug is only available via compassionate use or importation programs (e.g., CDC Drug Service in the United States).
* **Compliance:** The 10-day course must be completed in full to prevent recurrence of cyst shedding.
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**Educational Disclaimer:** This information is intended for educational purposes for healthcare professionals. Clinical practice guidelines and drug availability can vary significantly by region. Always verify specific dosing, safety, and regulatory status against your institution’s current formulary and official prescribing information before ordering or administering medication.
