Paromomycin (aminosidine, humatin) is an aminoglycoside given orally to treat E. histolytica cryptosporidiosis, and giardiasis. A topical formulation is used to treat trichomoniasis and cutaneous leishmaniasis, and parenteral administration has been used for visceral leishmaniasis.

Paromomycin shares the same mechanism of action as other aminoglycosides and has the same spectrum of antibacterial activity and toxicity (see Chapter 45). Paromomycin is available only for oral use in the U.S. Following oral administration, 100% of the drug is recovered in the feces, even with compromised gut integrity.

Paromomycin is the drug of choice for intestinal colonization with E. histolytica and is used in combination with metronidazole to treat amebic colitis and amebic liver abscess. Dosing for adults and children is 25—35 mg/kg/day orally in three divided doses. Adverse effects are rare, but include abdominal pain and cramping, epigastric pain, nausea and vomiting, steatorrhea, and diarrhea. Rarely, rash and headache have been reported. Paromomycin has been used to treat cryptosporidiosis in AiDS patients both as a single agent (oral doses of 500 mg three times daily or 1 g orally twice daily for 14—28 days followed by 500 mg orally twice daily) and in combination with azithromycin (paromomycin 1 g orally twice daily plus azithromycin 600 mg orally once daily for 4 weeks, followed by paromomycin alone for 8 weeks). Paromomycin has been advocated as a treatment for giardiasis in pregnant women, especially during the first trimester when metronidazole is contraindicated, and as an alternative agent for metronidazole-resistant isolates of G. intestinalis. Response rates of 55—90% have been reported. Dosing in adults is 500 mg orally three times daily for 10 days, whereas children have been treated with 25—30 mg/kg/day in three divided oral doses. Paromomycin formulated as a 6.25% cream has been used to treat vaginal trichomoniasis in patients who failed or could not receive metronidazole therapy. Cures have been reported, but vulvovaginal ulcerations and pain have complicated treatment.

Paromomycin as a topical formulation containing 15% paromomycin in combination with either a patented base or 12% methylbenzonium chloride has shown variable efficacy for the treatment of cutaneous leishmaniasis. Paromomycin has been administered parenterally (doses of 16—18 mg/kg/day) alone or in combination with antimony to treat visceral leishmaniasis. In one study, cure rates of 89% with paromomycin alone were reported, and cure rates of 94% were seen with combination therapy. These results compared favorably with those with antimony alone in areas where antimony resistance is common.

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