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Amoebic liver abscess medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]
Overview[edit | edit source]
Indications for medical management of amoebic liver abscess are all non-complicated abscesses, without compression effect, and without features of rupture or impending rupture. Treatment of intraluminal infection include iodoquinol, metronidazole, tinidazole, and paromomycin.[1]
Medical Therapy[edit | edit source]
The primary mode of treatment is drug therapy or percutaneous catheter drainage. The four main groups of treatment modalities effective in the treatment of amoebic liver abscess include:
- Drug therapy only
- Ultrasound guided aspiration and drug therapy only
- Percutaneous catheter drainage and drug therapy
- Laparotomy, drainage, and drug therapy
Indications for medical management:
- All non-complicated abscesses
- Without compression effect
- Without features of rupture or impending rupture
Pharmacotherapy for E histolytica include:
| Site Of Infection | Treatment |
|---|---|
| Intraluminal infection | Iodoquinol 650mg tid X 20 days Diloxanide furoate 500mg tid X 20 days Paromomycin 30mg/kg/day X 10 days (in 3 divided doses) |
| Amoebic liver abscess | Metronidazole 800mg tid PO X 10days (500mg qid IV) |
| Invasive colitis | Metronidazole 800mg tid X 5 days Tinidazole 1 gm bd X 3 days |
Current treatment recommendations of E histolytica includes
- With medical therapy alone, the cure rates of more than 90% have been reported, with the resolution of pain, fever, and anorexia with in 72h to 96h.[1]
- Pharmacotherapy is the first line treatment for amoebic liver abscess
| Treatment phase | Drug | Adult | Pediatric |
|---|---|---|---|
| Initial treatment of amoebic liver abscess | Metronidazole | 750 mg PO TID × 7–10 days | 35–50 mg/kg/day divided TID × 7–10 days |
| Tinidazole | 2 g once PO daily × 3 days | >3 years: 50 mg/kg/day (max 2 g) PO in 1 dose × 3 days | |
| Clearance of luminal cysts | Iodoquinol | 650 mg PO TID × 20 days | 30–40 mg/kg/day divided TID × 20 days (max 2 g/day) |
| Paromomycin | 500 mg PO TID × 7 days OR
25–35 mg/kg/day divided TID × 7 days |
25–35 mg/kg/day divided TID × 7 days |
References[edit | edit source]
- ↑ 1.0 1.1 Petri WA, Singh U (1999). "Diagnosis and management of amebiasis". Clin Infect Dis. 29 (5): 1117–25. doi:10.1086/313493. PMID 10524950.
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