Antiamoebic drugs for treating amoebic colitis

Abstract

Background Infection with the protozoan Entamoeba histolytica is common in low‐ and middle‐income countries, and up to 100,000 people with severe disease die every year. Adequate therapy for amoebic colitis is necessary to reduce illness, prevent development of complicated disease and extraintestinal spread, and decrease transmission. Objectives To evaluate antiamoebic drugs for treating amoebic colitis. Search methods We searched the available literature up to 22 March 2018. We searched the Cochrane Infectious Diseases Group Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, m RCT, and conference proceedings. We contacted individual researchers, organizations, and pharmaceutical companies, and we checked reference lists. Selection criteria Randomized controlled trials of antiamoebic drugs given alone or in combination, compared with placebo or another antiamoebic drug, for treating adults and children with a diagnosis of amoebic colitis. Data collection and analysis Two review authors independently assessed the eligibility and methodological quality of trials and extracted and analysed the data. We calculated clinical and parasitological failure rates and rates of relapse and adverse events as risk ratios (RRs) with 95% confidence intervals (CIs), using a random‐effects model. We determined statistical heterogeneity and explored possible sources of heterogeneity using subgroup analyses. We carried out sensitivity analysis by using trial quality to assess the robustness of reported results. Main results In total, 41 trials (4999 participants) met the inclusion criteria of this review. In this update, we added four trials to the 37 trials included in the first published review version. Thirty trials were published over 20 years ago. Only one trial used adequate methods of randomization and allocation concealment, was blinded, and analysed all randomized participants. Only one trial used an E histolytica stool antigen test, and two trials used amoebic culture. Tinidazole may be more effective than metronidazole for reducing clinical failure (RR 0.28, 95% CI 0.15 to 0.51; 477 participants, eight trials; low‐certainty evidence) and is probably associated with fewer adverse events (RR 0.65, 95% CI 0.46 to 0.92; 477 participants, 8 trials; moderate‐certainty evidence). Compared with metronidazole, combination therapy may result in fewer parasitological failures (RR 0.36, 95% CI 0.15 to 0.86; 720 participants, 3 trials; low‐certainty evidence), but we are uncertain which combination is more effective than another. Evidence is insufficient to allow conclusions regarding the efficacy of other antiamoebic drugs. Authors' conclusions Compared with metronidazole, tinidazole may be more effective in reducing clinical failur...

Persistent abdominal pain of a middle aged old female– Think of Amoebic Colitis

“…Cröhn's disease involves the small and large intestine in patches with typical skip areas and transmural involvement is also common. 4,5 In the index case, no skip area, creeping fat or fistula was noted. Microscopically, there were no features of activity or chronicity to suggest a possibility of inflammatory bowel disease.…”

Persistent abdominal pain of a middle aged old female– Think of Amoebic Colitis

“…Cröhn's disease involves the small and large intestine in patches with typical skip areas and transmural involvement is also common. 4,5 In the index case, no skip area, creeping fat or fistula was noted. Microscopically, there were no features of activity or chronicity to suggest a possibility of inflammatory bowel disease.…”

Antigiardial Activity of Some Plant Extracts Used in Traditional Medicine in Sudan in Comparison with Metronidazole

“…Najumudin, Ayubu, Elnazeer Metronidazole remains a preferable drug for the treatment of giardiasis though it can be substituted with Trigonella foenum graecum because it had almost same activity against giardia basing on the study results. Metronidazole is the first drug of choice recommended by the World Health Organization (WHO) for amoebiasis and giardiasis treatment [28]. However it has adverse side effects for example nausea, loss of appetite, vomiting, diarrhoea, lethargy, weakness, anemia, blood in the urine, head tilt, seizures, disorientation, and stumbling of metronidazole reported by Gholami et al [9].…”

A case report of refractory amebic colitis and literature review

“…[ 19 ] However, a systemic review showed that tinidazole demonstrated greater therapeutic efficacy with fewer adverse events. [ 20 ] Parasite resistance to MTZ has been observed in vitro, [ 21 ] which may be associated with an increased expression of iron-containing superoxide dismutase and peroxiredoxin. [ 22 ] Moreover, some clinical strains of E. histolytica have been reported to exhibit partial resistance to MTZ, indicating the potential development of MTZ-resistant strains.…”

“…A comprehensive review suggested that a combination drug therapy achieved a reduction of 60% in clinical and parasitological failure than MTZ alone for eliminating amebae. [ 20 ] However, there is insufficient information to establish the most effective combination anti-amebic drug regimen. Therefore, for symptomatic amebic colitis, the drug treatment of amebiasis is termed as a 2-drug approach: tissue amebicides like nitroimidazole or MTZ to eliminate invading trophozoites, [ 25 ] and luminal amebicides like paromomycin or diloxanide to eradicate intraluminal carriage of cysts.…”

Persistent abdominal pain of a middle aged old female– Think of Amoebic Colitis

“…Cröhn's disease involves the small and large intestine in patches with typical skip areas and transmural involvement is also common. 4,5 In the index case, no skip area, creeping fat or fistula was noted. Microscopically, there were no features of activity or chronicity to suggest a possibility of inflammatory bowel disease.…”

Antigiardial Activity of Some Plant Extracts Used in Traditional Medicine in Sudan in Comparison with Metronidazole

“…Najumudin, Ayubu, Elnazeer Metronidazole remains a preferable drug for the treatment of giardiasis though it can be substituted with Trigonella foenum graecum because it had almost same activity against giardia basing on the study results. Metronidazole is the first drug of choice recommended by the World Health Organization (WHO) for amoebiasis and giardiasis treatment [28]. However it has adverse side effects for example nausea, loss of appetite, vomiting, diarrhoea, lethargy, weakness, anemia, blood in the urine, head tilt, seizures, disorientation, and stumbling of metronidazole reported by Gholami et al [9].…”

A case report of refractory amebic colitis and literature review

“…[ 19 ] However, a systemic review showed that tinidazole demonstrated greater therapeutic efficacy with fewer adverse events. [ 20 ] Parasite resistance to MTZ has been observed in vitro, [ 21 ] which may be associated with an increased expression of iron-containing superoxide dismutase and peroxiredoxin. [ 22 ] Moreover, some clinical strains of E. histolytica have been reported to exhibit partial resistance to MTZ, indicating the potential development of MTZ-resistant strains.…”

“…A comprehensive review suggested that a combination drug therapy achieved a reduction of 60% in clinical and parasitological failure than MTZ alone for eliminating amebae. [ 20 ] However, there is insufficient information to establish the most effective combination anti-amebic drug regimen. Therefore, for symptomatic amebic colitis, the drug treatment of amebiasis is termed as a 2-drug approach: tissue amebicides like nitroimidazole or MTZ to eliminate invading trophozoites, [ 25 ] and luminal amebicides like paromomycin or diloxanide to eradicate intraluminal carriage of cysts.…”

Persistent abdominal pain of a middle aged old female– Think of Amoebic Colitis

“…Cröhn's disease involves the small and large intestine in patches with typical skip areas and transmural involvement is also common. 4,5 In the index case, no skip area, creeping fat or fistula was noted. Microscopically, there were no features of activity or chronicity to suggest a possibility of inflammatory bowel disease.…”

Antigiardial Activity of Some Plant Extracts Used in Traditional Medicine in Sudan in Comparison with Metronidazole

“…Najumudin, Ayubu, Elnazeer Metronidazole remains a preferable drug for the treatment of giardiasis though it can be substituted with Trigonella foenum graecum because it had almost same activity against giardia basing on the study results. Metronidazole is the first drug of choice recommended by the World Health Organization (WHO) for amoebiasis and giardiasis treatment [28]. However it has adverse side effects for example nausea, loss of appetite, vomiting, diarrhoea, lethargy, weakness, anemia, blood in the urine, head tilt, seizures, disorientation, and stumbling of metronidazole reported by Gholami et al [9].…”

A case report of refractory amebic colitis and literature review

“…[ 19 ] However, a systemic review showed that tinidazole demonstrated greater therapeutic efficacy with fewer adverse events. [ 20 ] Parasite resistance to MTZ has been observed in vitro, [ 21 ] which may be associated with an increased expression of iron-containing superoxide dismutase and peroxiredoxin. [ 22 ] Moreover, some clinical strains of E. histolytica have been reported to exhibit partial resistance to MTZ, indicating the potential development of MTZ-resistant strains.…”

“…A comprehensive review suggested that a combination drug therapy achieved a reduction of 60% in clinical and parasitological failure than MTZ alone for eliminating amebae. [ 20 ] However, there is insufficient information to establish the most effective combination anti-amebic drug regimen. Therefore, for symptomatic amebic colitis, the drug treatment of amebiasis is termed as a 2-drug approach: tissue amebicides like nitroimidazole or MTZ to eliminate invading trophozoites, [ 25 ] and luminal amebicides like paromomycin or diloxanide to eradicate intraluminal carriage of cysts.…”