The treatment of amebiasis by a combined method—statistical end results

Summary

• 1. The most effective amebicidal drug now known fails in 10% of the cases to produce a permanent cure, when used alone as single drug therapy, and in a single course of treatment. There are disadvantages to any method which requires repeated courses of drug therapy. Therefore, a simple method of combined drug treatment which has reduced the therapeutic failures from 10% to 3%, with a single course of therapy, and which has produced no unfavorable drug reaction in 104 cases, seems worth reporting.

• 2. It has seemed important to review in detail the therapeutic effectiveness and the toxicity or lack of toxicity of each of the four outstanding amebicidal drugs.

• 3. The combined method of amebicidal drug therapy employed in treating this group of 104 cases consisted of administering by mouth a single course of carbarsone, consisting of 0.25 gram before breakfast and supper each day for ten days, and simultaneously giving 250 cc. of a 2.5% chiniofon (“Yatren”) solution as a retention enema every other day during this ten day period, for a total of five treatments. These chiniofon enemata are given by a special technique, which is described.

• 4. The clinical material utilized consisted of an unselected group of 104 cases of uncomplicated amebiasis. (Two cases of acute amebic hepatitis and hepatic abscess were not included in this group since they received emetine). Upon the basis of differences in clinical manifestations, the 104 cases are divided into five sub-groups. (See Table I). As regards severity of infection, there is evidence that the cases of amebiasis treated in this clinic represent an average cross section of amebiasis, as seen in the temperate zone. In the tropical and subtropical zones it is recognized that infection with amebiasis tends to be more acute.

• 5. The warm stool and proctoscopic findings in the various clinical subgroups of cases are summarized in Tables II and III. The method of collection and examination of warm stools is described.

• 6. The routine procedure of follow-up stool examinations, after amebicidal treatment in this clinic, has consisted of a careful warm stool examination by the same experienced parasitologist every week for four weeks after drug therapy, then every month for five months, and subsequently every six months for a total period of three years, or longer whenever possible. The period of follow-up stool study has varied from six months to 31/2 years. The number of cases having various periods of follow-up stool examinations is specified in Table IV.

• 7. After using the above method of combined treatment, there was persistent absence of amebae from the stools in 97%, or 101 out of the 104 cases.