Treatment

Three medications are used most often to treat Balantidium coli:  tetracycline, metronidazole, and iodoquinol.

Tetracycline*: adults, 500 mg orally 4 times daily for 10 days; children ≥ 8 years old, 40 mg/kg/day (max. 2 g) orally in 4 doses for 10 days. (Note: Tetracyclines are contraindicated in pregnancy and in children < 8 years old. Tetracycline should be taken 1 hour before or 2 hours after meals or ingestion of dairy products.)

Alternatives:

Metronidazole*: adults, 500-750 mg orally 3 times daily for 5 days; children, 35-50 mg/kg/day orally in three doses for 5 days.

OR

Iodoquinol*: adults, 650 mg orally 3 times daily for 20 days; children, 30-40 mg/kg/day (max 2 g) orally in 3 doses for 20 days. (Note: iodoquinol should be taken after meals.)

Nitazoxanide*: has been tried in small studies, which suggest some therapeutic benefit (adults, 500 mg orally twice daily for 3 days; children age 4-11 years old 200 mg orally twice daily for 3 days; children 1-3 years old 100 mg orally twice daily for 3 days).

*Not FDA-approved for this indication