Amoebic liver abscess medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S [2]

Overview

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

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
Initial treatment of amoebic liver abscess	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)
Clearance of luminal cysts	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

↑ ^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.

[pmid10524950-1] 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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