A 3-year-old child presents with 3 days of acute watery diarrhea, mucus, and blood. Stool microscopy shows trophozoites with ingested RBCs. After starting metronidazole, what is the purpose of adding a luminal amoebicide (diloxanide furoate) after completing the metronidazole course?

• A To treat concurrent Giardia co-infection
• B To cover metronidazole-resistant Entamoeba strains
• C To treat invasive disease in the liver if metronidazole is inadequate
• D To eradicate luminal cysts and prevent relapse and transmission ✓

Explanation

Metronidazole is effective against invasive amoebiasis (tissue trophozoites) but achieves poor luminal concentrations and does not reliably eliminate intraluminal cysts. Diloxanide furoate, a luminal amoebicide, is added after the metronidazole course to eradicate cysts remaining in the colon, preventing relapse and stopping onward transmission to household contacts. This combination is the standard treatment for all symptomatic intestinal amoebiasis in children. Paromomycin is an alternative luminal amoebicide if diloxanide is unavailable.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.