Metronidazole + Diloxanide Furoate
Indications
Metronidazole + Diloxanide Furoate is used for:
Treatment of amoebiasis, other protozoal disease.
Adult Dose
Oral
1 (400/500mg) Tablet 3 times daily for 7-10 days.
Susp: (200/250 mg/5ml): 2 tsf 3 times daily.
Child Dose
Oral
Child
Susp: (200/250 mg/5ml): 1-2 tsf 3 times daily.
Renal Dose
Administration
Contra Indications
Hypersensitivity, blood dyscrasias, active CNS disease, serious neurological disease, seizures, severe hepatic failure, 1st trimester pregnancy, lactation.
Precautions
Severe Renal & Hepatic impairment. Caution should be exercised in pregnant and breastfeeding women.
Pregnancy-Lactation
Interactions
Acute psychoses with disulfiram. Additive or synergistic effect with other antimicrobials. Disulfiram like reaction with alcohol. Enhances action of coumarin anticoagulants. Blood levels increased by cimetidine. Effect reduced by phenobarbitone.
Adverse Effects
Side effects of Metronidazole + Diloxanide Furoate :
Seizures, headache, dizziness, peripheral neuropathies, unpleasant metallic taste, furred tongue, glossitis, pseudomembranous colitis, GI disturbances, rash, urticaria, pruritus, paraesthesias, superinfection; transient leucopaenia, thrombocytopenia. Raised liver enzyme values, cholestatic hepatitis, jaundice.
Mechanism of Action
Metronidazole is converted to reduction products that interact w/ DNA to cause destruction of helical DNA structure and strand leading to a protein synthesis inhibition and cell death in susceptible organisms. It is active against most anaerobic protozoa, some gm+ve, gm-ve and facultative anaerobes.
Diloxanide is a luminal amoebicide which is hydrolysed in the gut, thus releasing the free diloxanide which acts as an amoebicide. It is given alone in asymptomatic cyst passers. For patients with active amoebic infections, it can be administered with a 5-nitroimidazole e.g. metronidazole or tinidazole.