His medical history is relevant for recent travelling to Mexico

A 37-year-old man comes to the emergency department because of sudden explosive diarrhea and intermittent abdominal pain. His medical history is relevant for recent travelling to Mexico. Upon further questioning, the patient mentions that he feels an uncontrollable urgency to defecate that does not cease after defecation. When the patient is asked about his stools, he describes them as “bloody and foul-smelling.” Physical examination shows decreased alertness, sunken eyes, dry mouth, split skin on mouth corners, and abdominal tenderness on palpation. His temperature is 38.6°C (101.48°F), pulse is 122/min, respirations are 24/min, blood pressure is 90/70 mmHg. Laboratory studies show leukocytosis and elevated alkaline phosphatase. Microscopy of a stool sample is obtained and shown below.
Which of the following is the most appropriate initial treatment for this patient?

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  1. Paromomycin
  2. Iodoquinol
  3. Albendazole
  4. Oral rehydration therapy
  5. Metronidazole