Prophylaxis and Treatment
Prophylaxis.—The main consideration is a knowledge of the importance of the carrier problem. The stools of all persons preparing food in localities where amoebic dysentery is prevalent should therefore be examined for the 4-nucleated cyst of the pathogenic amoeba. It must be remembered that while emetine controls the dysenteric manifestations of amoebiasis it does not seem to cause the disappearance of the parasite, so that patients who have had amoebic dysentery tend to become carriers.
As a matter of fact there is a question as to the possibility of the emetine treatment acting as a factor for the increase of carriers.
Vedder considers that while emetine will kill the amoebae deeply placed in the submucosa it has no effect on the more superficially located cysts and suggests that it may be possible to treat carriers by colonic irrigations with quinine or silver salts.
Emetine bismuth iodide has recently been highly recommended as our best agent for eradication of E. histolytica cysts of carriers.
Treatment.—The emetine treatment may now be considered as the specific one for amoebic dysentery. In Brazilian ipecac about 72% of the total alkaloids is emetine, so that it is better than Carthagena ipecac which contains only about 40% of emetine. Emetine was recommended for dysentery as long ago as 1817, but owing to the impossibility of differentiating between bacillary and amoebic dysentery, until recently, this method of treatment was little advocated.
In 1910 Vedder found that emetine was practically without power in its action on dysentery bacilli but that it would kill amoebae, even in dilutions of 1 to 100,000. He also found that deëmetized ipecac was quite inert in its action on amoebae.
In 1912, Rogers, who had for years been an ardent advocate of the ipecac treatment of amoebiasis, took up the treatment of amoebic dysentery and its liver complications with emetine. Reports from all over the world now attest the value of this drug in the treatment of the acute manifestations of amoebiasis but unfortunately note the inefficacy of this treatment on the encysted forms of amoebae.
It is usual to give from ⅓ to ⅔ grain of emetine hydrochloride, dissolved in sterile saline, by hypodermic injection into the subcutaneous tissues. Some now give as high as 1 grain daily for about ten days, but Vedder prefers ⅓ grain repeated 3 times daily. In these doses there is practically no nausea.