Several antibiotics have been used to treat intestinal protozoal infections. Erythromycin and tetracycline do not have a direct effect on the protozoa; they act by altering intestinal bacterial flora and preventing secondary infection. Tetracycline also reduces the normal gastrointestinal bacterial flora on which the amebas depend for growth.

The aminoglycoside paromomycin (Humatin) has a mode of action identical to that of the other aminocycli-tols and is directly amebicidal. It is not absorbed from the intestinal tract and thus has its primary effect on bacteria, some amebas (e.g., E. histolytica), and some helminths found in the lumen of the intestinal tract. Side effects are limited to diarrhea and gastrointestinal upset.

Amphotericin B, a polyene, is discussed more fully in Chapter 52. It has produced healing of the mucocuta-neous lesions of American leishmaniasis, but its potential for nephrotoxicity makes it a drug of second choice. On the other hand, liposomal amphotericin B, approved by the U. S. Food and Drug Administration (FDA) for treatment of visceral leishmaniasis, is considered the drug of choice for that indication and is much less toxic than pentavalent antimonials or amphotericin B.

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