Treatment of Amebic Liver Abscess

Extra intestinal infection by Entamoeba histolytica commonly leads to involvement of liver and amebic liver abscess. In developing countries amebic liver abscess is usually seen among travelers who visit an area where amebiasis is endemic and generally develop amebic liver abscess (95%) within 5 months after leaving the endemic area. In endemic areas amebic liver abscess may develop to anybody infected with Entamoeba. Amebic liver abscess if left untreated or if not treated adequately may lead to complications such as involvement of lungs and pleura (reported to occur in as many as 20-30% of amebic liver abscess), the abscess may rupture into peritoneum and occasionally may involve pericardium of the heart with grave prognosis.

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Treatment of amebic liver abscess:

The drug of choice in treatment of amebic liver abscess is metronidazole at the dose of 750 mg orally or intravenously three times a day for 5-10 days. With the use of metronidazole, the mortality from amebic liver abscess is below 1%.

Other drugs which are effective in treatment of amebic liver abscess are longer-acting nitroimidazoles such as tinidazole and ornidazole (not available in United States), which are effective as a single dose therapy.

The second line drugs in treatment of amebic liver abscess include emetine and chloroquine.

Combination of more than one drug is not superior to use of single drug as there is no evidence at present of the superiority of combining two or more anti amebic drugs. The treatment regimen for amebic liver abscess should include use of luminal amebicides such as iodoquinol, paromomycin, diloxanide furoate or quiniodochlor for eradication of cysts and prevent further transmission.

Aspiration of amebic liver abscess:

The response to conventional medical therapy with metronidazole gives dramatic result in more than 90% of amebic liver abscess and reduces pain and fever within 3 days. But sometimes the abscess may require aspiration. The indications of aspiration of amebic liver abscess are:

  • If there is no response to medical therapy in 3-5 days.
  • To rule out pyogenic abscess in patients with multiple lesions in liver.
  • If there is threat of imminent rupture of the abscess.
  • To prevent rupture of left-lobe abscesses of liver into the pericardium, this usually results in grave consequence.

But there is no evidence that aspiration of amebic liver abscess (even large abscesses) leads to faster healing of the abscess. If the liver abscess has already ruptured percutaneous drainage can be done. Surgery is generally reserved for if there is bowel perforation and rupture of amebic liver abscess into the pericardium.

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