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Paromomycin sulfate is an aminoglycoside antibiotic that is not significantly absorbed from the gastrointestinal tract. It is used only as a luminal amebicide and has no effect against extraintestinal amebic infections. The small amount absorbed is slowly excreted unchanged, mainly by glomerular fil-tration. However, the drug may accumulate with renal insuffi-ciency and contribute to renal toxicity. Paromomycin is an effective luminal amebicide that appears to have similar efficacy and probably less toxicity than other agents; in a recent study, it was superior to diloxanide furoate in clearing asymptomatic infec-tions. Adverse effects include occasional abdominal distress and diarrhea. Parenteral paromomycin is now used to treat visceral leishmaniasis and is discussed separately in the text that follows.
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