Paromomycin Sulfate

Amebiasis

Treatment of acute and chronic intestinal amebiasis caused by Entamoeba histolytica.100 110 116 117 118 122

Treatment of asymptomatic cyst passers (intraluminal infections), especially in children and pregnant women.100 110 116 117 118

Not effective for and should not be used alone for treatment of extraintestinal amebiasis (including amebic liver abscess) caused by E. histolytica.117 122 Used to eradicate encysted E. histolytica in the intestinal lumen as follow-up after treatment with a tissue amebicide (metronidazole or tinidazole).100 110

Treatment of mild to moderate or severe symptomatic intestinal amebiasis or extraintestinal disease (including amebic liver abscess) involves the use of both a tissue and a luminal amebicide to ensure eradication of tissue-invading trophozoites as well as cysts in the intestinal lumen.100 110 116 117 118

Regimen of choice for symptomatic intestinal amebiasis or extraintestinal disease (including liver abscess) is a nitroimidazole derivative (oral metronidazole or oral tinidazole) followed by a luminal amebicide (oral iodoquinol or oral paromomycin).100 110 116 117 118

Some strains of Entamoeba are nonpathogenic (e.g., E. dispar, E. hartmanni) and asymptomatic intraluminal infections with these organisms generally do not require treatment.100 116 117 118

Balantidiasis

Has been used for treatment of balantidiasis† caused by Balantidium coli.a

Not a drug of choice.100 110 Tetracycline is the drug of choice and metronidazole and iodoquinol are alternatives for treatment of balantidiasis.100 110

Cestode (Tapeworm) Infections

Has been used for treatment of cestodiasis (tapeworm infection) caused by certain cestodes pathogenic to humans including Diphyllobothrium latum† (fish tapeworm), Dipylidium caninum† (dog and cat tapeworm), Hymenolepis nana† (dwarf tapeworm), Taenia saginata† (beef tapeworm), and T. solium† (pork tapeworm).a

Not a drug of choice.110 Praziquantel, niclosamide (not commercially available in the US), and nitazoxanide usually recommended for treatment of these tapeworm infections.110

Cryptosporidiosis

Treatment of cryptosporidiosis† caused by Cryptosporidium parvum in patients with HIV infection; used alone or in conjunction with azithromycin.100 111 115 120 126 127 128

No anti-infective has been found to reliably eradicate Cryptosporidium, although several drugs (e.g., paromomycin, azithromycin, nitazoxanide) appear to suppress the infection.114 126 127 128

CDC, NIH, IDSA, and others state that the most appropriate treatment for cryptosporidiosis in HIV-infected individuals is the use of potent antiretroviral agents (to restore immune function) and symptomatic treatment of diarrhea.126 127 128

Dientamoeba fragilis Infections

Treatment of infections caused by Dientamoeba fragilis†.110

Iodoquinol, paromomycin, tetracycline, or metronidazole are drugs of choice for treatment of D. fragilis infections.110

Giardiasis

Treatment of giardiasis† caused by Giardia duodenalis (also known as G. lamblia or G. intestinalis).100 110 119

Drugs of choice are metronidazole, tinidazole, or nitazoxanide; alternatives are paromomycin (especially in pregnant women), furazolidone (not commercially available in the US), or quinacrine (not commercially available in the US).100 110

Although paromomycin may be less effective than the other agents, it is poorly absorbed from the GI tract and may be useful for treatment of giardiasis in pregnant women.100 110 119

Hepatic Encephalopathy

Has been used in the management of hepatic coma as an adjunct122 to protein restriction and supportive therapy to inhibit nitrogen-forming bacteria in the GI tract.a

Not a preferred or alternative treatment; nonabsorbable disaccharides (lactulose) or certain other anti-infectives (neomycin or metronidazole) usually recommended.123 124 a

Leishmaniasis

Has been used topically† (in conjunction with topical methylbenzethonium chloride) for treatment of cutaneous leishmaniasis†, including infections caused by Leishmania major, L. braziliensis, and L. mexicana.103 104 105 106 110 121 129

Has been used IM† for treatment of visceral leishmaniasis (kala azar) caused by L. donovani.121 129 130

For treatment of cutaneous leishmaniasis, pentavalent antimony compounds (IM or IV sodium stibogluconate or meglumine antimonate [drugs not commercially available in the US]) are drugs of choice;110 121 129 topical† paromomycin or IM or IV pentamidine are alternatives.110 121

For treatment of visceral leishmaniasis, pentavalent antimony compounds (e.g., IM or IV sodium stibogluconate or meglumine antimonate [drugs not commercially available in the US]) or IV amphotericin B (conventional or liposomal) are drugs of choice;110 121 129 130 IM or IV pentamidine or IM† paromomycin are alternatives.110

Topical† paromomycin should be used only in geographic regions where cutaneous Leishmania species have low potential for mucosal spread.110 Topical treatment cannot cure lymph node infection or protect against mucosal disease if metastasis has already started.121