Histomonosis (blackhead or infectious enterohepatitis) is a disease of gallinaceous birds, especially of turkeys, and is caused by the protozoan Histomonas meleagridis. Since the ban of all chemoprophylactic and chemotherapeutic products against this disease in the European Union, this parasite causes a considerable amount of economical problems in the poultry industry. Research which could ultimately lead to the discovery of new drugs against this disease is thus highly necessary. Hence, in this study, the efficacy of paromomycin against histomonosis in turkeys was investigated. First, the prophylactic and therapeutic efficacy of this drug against H. meleagridis and its effect on the weight gain of turkeys was determined. Adding paromomycin to the feed (400 ppm as well as 200 ppm paromomycin) or to the drinking water (420 mg paromomycin per liter water, added prior to or on the day of challenge) significantly lowered the mortality rate and the caecal and liver lesion scores after an intracloacal infection compared to infected untreated birds. However, when paromomycin was administered to turkeys in the drinking water after the challenge, no significant differences in mortality or in lesion scores could be observed compared to the infected untreated control group. This demonstrates that paromomycin exerts a purely preventive action against histomonosis in turkeys. Additionally, the weight gain of the treated birds was positively influenced by the use of the drug, as the average weight gain of all treated groups (except for the group treated at the day of first mortality) was significantly higher than that of the untreated control group. Finally, the target site of paromomycin was detected in the SS rRNA gene of H. meleagridis. Consequently, the susceptibility to paromomycin can be correlated to the presence of the binding site of the drug at the 3' end of the small subunit rRNA gene of the parasite. In conclusion, paromomycin can be used as a new prophylactic measure in the control of histomonosis in turkeys.