Oh boy (girl?), I was hoping I wouldn't have to explain :) as it's kinda lengthy...
But here it goes:
- Metronidazole (Flagyl) or Tinidazole (Fasygin) work on most anaerobic organisms. Actual way they work is not completely understood believe it not. But they do work, both on bacteria and protozoa. I am tempted to believe they would work on microsporidia too, but couldn't find any reports of anyone trying that therapy. Typically for microsporidia they use Albendazole, but that's all beside the point.
Metronidazole or Tinidazole have a very long history of successfull usage for even toughest cases of invasive amebiasis, so we can be quite certain of their effectiveness. However, resistant strains have emerged, mostly due to doctors not prescribing doses that are high enough or taken for long enough. It is possible to develop a resistant strain by taking less then the optimal dosage. After reading many reports, I came to conclusion that adults should take Metronidazole 750mg tid (tid = three times a day, or every 8 hours). However, Metronidazole has a very short half life, less then 8 hours. This means that it's levels go down pretty fast and way before the next dosage. So I was leaning towards taking it every 6 hours, perhaps 500mg every six hours, but I never tried that.
Tinidazole has a couple of advantages compared to Metronidazole: first it is less protein bound then Metronidazole (Metronidazole is 20% protein bound, Tinidazole 12% protein bound), and that's important because the other medication - Nitazoxanide - is almost 100% protein bound so they cancel each other out by that margin. The other advantage of Tinidazole is that it has a longer half life in blood, so taking it every eight hours should be enough to maintain a good level of it in bloodstream from day one. Most doctors suggest it to be taken only once a day 2000mg, but I think that 750mg tid is better as the blood level will be maintained better. Some people who have cured themselves of very stubborn amebiasis have also tried this method (three times a day, rather then once a day) with success, so we have their experience to go by as well.
The only reason that I would maybe reduce the dosage is if an adult is smaller in size. I am regular size adult, but people I know who took some of these medications were smaller then me yet they also took 750mg tid. But maybe for someone who is "XS" size, (110-130 lbs or so?) 500mg tid should do.
Both of these (Metronidazole and Tinidazole) can cause side effects. First of all you have to know that taking alcohol is an absolute no-no. Not a drop, no rum-filled chocolates and do not rinse your mouth with listerine. Some side effects that were observed I am sure were actually die-off symptoms. Or maybe they all are die-off symptoms as people who don't have amebiasis but take the same medication maybe as a post operative treatment or because of a bad tooth abscess, do not have these bad side effects. A few people have had convulsions and I think one person died when starting Metronidazole (had a convulsion and died) but with those people I think that they already had amoebas reach their brain in which case it is only a matter of time before they die. There is no cure for advanced stage of cerebral amebiasis except Metronidazole. (and I think one has only about 72 hours to do something once that happens, although symptoms may not be present at all - so how is one to know? One woman had lost her short term memory and sense of smell... and she died within three days of coming to hospital).
I had bad die off symptoms from day two to five. I had to stay in bed for the rest of the week too and it was really bad, but worst was in the begining. Take lots of water to wash all of that waste as they release toxins as they die (those same toxins they use to digest their way through you).
With Tinidazole, Nitazoxanide is a good combo as the two drugs work in totaly different ways. Many people have reported great success with it, even after other therapies have failed. Go to badbugs.org to see some testimonials although I don't agree with everything there, just a good place to see some testimonials that's all. There are also many reports of successfull usage of Nitazoxanide for really stubborn cases of amebiasis and it is used for children too, so it is pretty safe. I am not aware of any serious side effects with it. It is however protein bound, so it shouldn't be combined with other medication that is protein bound (unlikely that you are using those but check the internet if you want to see what not to take together with Nitazoxanide). Taking Nitazoxanide at the same time with Tinidazole is going to make it pretty much impossible for protozoa to hide or develop resistance. They both have excellent tissue penetration, are highly available soon after taking them (within about 2-3 hours), and have entirely different action so amoebas will be fighting on two fronts at the same time.
The third antibiotic, Furazolidone (Furoxone), is also an Antibiotic targeted at protozoa. I believe it also kills probiotic and other bacteria which helps as protozoa love to feed on those. Furazolidone is not a systemic antibiotic, so it works mostly in the bowel lumen. Furazolidone I would take for a whole month - the first two weeks while I am on Tinidazole, and then continuing for another two weeks while I am on Paromomycin. Furazolidone should be taken 100mg tid, so together with other two.
The above three medications can be found at medsmex.com.
The last and probably most important medication is Paromomycin (Humatin). It is a luminal amoebicide, meaning it only works within your bowels. But that's where amoebas will change into a hardy and very resistant cyst form, and will stay like that for weeks just waiting it out for therapy with medication to stop. Paromomycin works against these cysts, as does Furazolidone. Paromomycin needs to be taken three times daily also, at least 500mg to 750mg each time. Do not exceed 2000mg daily (or 750mg tid) it can be too toxic especially if you have a leaky gut and most people who suffer from parasites have leaky gut.
Getting a hold of Paromomycin is a problem. It can be bought over the counter in some far out places like Thailand, or Iran, or Bulgaria I think. I haven't found an on-line source for it though. See if you can find an MD who will give you a scriipt for it or try to find out who has it, or if someone can buy it for you where they live. Other names for it are: Humatin, Gabroral, and so on.
There are other things to do besides medication:
- First of all, a couple of weeks before starting the medication, buy a product called "Happy tummy". I don't have a link for it, but it is based on Senna, which has excellent anti-parasitic properties. It will also help clear your intestines out, and will give you a head start as your parasitic load will be less. Even though on the box it says to take a tablespoon or two of it, I take only one teaspoon twice daily. If you want to clear yourself out quickly, then take two tablespoons and be ready to spend next 12-18 hours in the bathroom.
- Adjust your diet to only fish, chicken and green and leafy vegetables. Fruits are not to be eaten at all, except for grapefruit. Nothing sweet, nothing that has any GI level at all, meaning only the foods with lowest GI. parasites feed on glucose so you have to eat foods which don't release tons of it at the time. This means that you won't be eating any starches for a long time to come. Not even a single bite of pizza, or white bread. You will not get better if you succumb to your taste buds even only a little bit or just once. I tried it and the reaction was terrible and horrifying enough that I could see why those foods are not to be eaten: you are quickly back to square one after such a meal. This happened after I ate a bowl of soup that had a few bits of carrots in it (any root vegetables like carrots, potatoes, and even onions are all starches and have high GI).
- parasites also need serotonin so don't eat any nuts at all. The fastest way to go back to square one is pistaccios or peanuts or walnut. Try them and you'll regret it.
- Drink plenty of good filtered or bottled water during all this (at least 2 quarts per day), to wash out the toxins and to prevent parasites from encysting. Drink some of it with a little lemon in the water; it seems that some protozoa can envelop themselves in fat, so lemon enzymes (and grapefruit) will take care of that.
- Avoid stress like the plaque and make sure you believe that this will work. Without these two, it will all fail. No nasty phonecalls, no stress from work. Take a vacation or some time off from work at least the first 10-15 days.
Stick to that diet for a few weeks after the therapy even if that means loosing weight.