Paromomycin is an antimicrobial used to treat a number of parasitic infections including amebiasis, giardiasis, leishmaniasis, and tapeworm infection. It is a first line treatment for amebiasis or giardiasis during pregnancy. Otherwise it is generally a second line treatment option. It is used by mouth, applied to the skin, or by injection into a muscle.Chagas disease: nitroimidazole (Benznidazole#)Pentavalent antimonials (Meglumine antimoniate#, Sodium stibogluconate) Paromomycin is an antimicrobial used to treat a number of parasitic infections including amebiasis, giardiasis, leishmaniasis, and tapeworm infection. It is a first line treatment for amebiasis or giardiasis during pregnancy. Otherwise it is generally a second line treatment option. It is used by mouth, applied to the skin, or by injection into a muscle. Common side effects when taken by mouth include loss of appetite, vomiting, abdominal pain, and diarrhea. When applied to the skin side effects include itchiness, redness, and blisters. When given by injection there may be fever, liver problems, or hearing loss. Use during breastfeeding appears to be safe. Paromomycin is in the aminoglycoside family of medications and causes microbe death by stopping the creation of bacterial proteins. Paromomycin was discovered in the 1950s from a type of streptomyces and came into medical use in 1960. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. Paromomycin is available as a generic medication. In India the injectable form is about 4.19 to 8.38 pounds for a course of treatment as of 2007. In the United States a typical course of treatment is more than US$200 as of 2015. It is an antimicrobial used to treat intestinal parasitic infections such as cryptosporidiosis and amoebiasis, and other diseases such as leishmaniasis.Paromomycin was demonstrated to be effective against cutaneous leishmaniasis in clinical studies in the USSR in the 1960s, and in trials with visceral leishmaniasis in the early 1990s. The route of administration is intramuscular injection and capsule.Paromomycin topical cream with or without gentamicin is an effective treatment for ulcerative cutaneous leishmaniasis, according to the results of a phase-3, randomized, double-blind, parallel group–controlled trial. The medication is poorly absorbed. The effect it may have on the baby is still unknown. There is limited data regarding the safety of taking paromomycin while breastfeeding but because the drug is poorly absorbed minimal amounts of drug will be secreted in breastmilk. There is limited evidence that paromomycin can be used in persons coinfected with HIV and Cryptosporidium. A few small trials have showed a reduction in oocyst shedding after treatment with paromomycin. The most common adverse effects associated with paromomycin sulfate are abdominal cramps, diarrhea, heartburn, nausea, and vomiting. Long-term use of paromomycin increases the risk for bacterial or fungal infection. Signs of overgrowth include white patches in the oral cavities. Other less common adverse events include myasthenia gravis, kidney damage, enterocolitis, malabsorption syndrome, eosinophilia, headache, hearing loss, ringing in the ear, itching, severe dizziness, and pancreatitis.