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# Diloxanide Furoate
## Overview
Diloxanide furoate is a luminal amebicide that acts directly on *Entamoeba histolytica* in the intestinal lumen. It is poorly absorbed systemically and is ineffective against extraintestinal (tissue) amebiasis.
## Primary Indications
Treatment of asymptomatic intestinal colonization (*E. histolytica* cysts). It is often used as a follow-up agent after treatment with a tissue amebicide (e.g., metronidazole) for symptomatic invasive amebiasis to eliminate remaining luminal cysts.
## Adult Dosing
500 mg orally three times daily for 10 days.
## Pediatric Dosing
20 mg/kg/day divided into three doses three times daily for 10 days.
*Note: Maximum daily dose is 1,500 mg.*
## Dose Adjustments
There are no standardized guidelines for renal or hepatic impairment. Given limited systemic absorption, clinical caution is advised if significant hepatic or renal dysfunction is present.
## Contraindications
Hypersensitivity to diloxanide furoate. Not indicated for invasive (extraintestinal) amebiasis, such as liver abscesses.
## Adverse Effects
* **Common:** Flatulence, nausea, vomiting, abdominal cramps, and pruritus/urticaria.
* **Serious:** Rare reports of idiosyncratic hypersensitivity.
## Key Drug Interactions
No major clinically significant drug-drug interactions are documented due to its localized site of action and low systemic bioavailability.
## Monitoring
Monitor for resolution of gastrointestinal symptoms and microbiological clearance (stool microscopy for cysts) if clinical suspicion of persistent infection remains.
## Clinical Pearls
* **Not for invasive disease:** Must be used in combination with a systemic agent (e.g., metronidazole, tinidazole) for invasive amebic dysentery or liver abscess.
* **Compliance:** The 10-day course is essential to ensure eradication of the cyst stage and prevent transmission.
* **Availability:** Diloxanide furoate is not FDA-approved in the United States; it may be obtained via the CDC Drug Service for specialized indications.
* **Safety:** It is considered the agent of choice for treating asymptomatic cyst passers to prevent personal morbidity and community transmission.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical protocols and availability vary by jurisdiction. Pharmacy and clinical staff must verify current prescribing information and institutional guidelines via the CDC, local formulary, or primary medical literature before implementation.
