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
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
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 |
| 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
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.
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