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

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.

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.
• 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