A 31-year-old man with a large amoebic liver abscess is treated with a full course of metronidazole and improves clinically. Which additional agent should be given after the nitroimidazole course to prevent relapse from persistent intestinal infection?
- A Praziquantel
- B Paromomycin or diloxanide furoate ✓
- C Albendazole
- D Nitazoxanide alone
Correct answer: B. Paromomycin or diloxanide furoate
Explanation
Metronidazole achieves high tissue levels and eradicates trophozoites in the liver and bowel wall, but it is unreliable in clearing cysts from the intestinal lumen. B luminal amoebicide such as diloxanide furoate or paromomycin must follow the tissue amoebicide to eliminate residual encysted organisms and prevent relapse. Albendazole and praziquantel have no activity against Entamoeba histolytica, and nitazoxanide is not the standard follow-on agent in this setting. This sequential approach is standard Indian practice.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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