Treatment of Amoebic Liver Abscess

In this article, we will discuss the Treatment of Amoebic Liver Abscess. So, let’s get started.

Treatment

1. Relief of pain and fever with analgesics.

2. Drug treatment: Single drug therapy with metronidazole (800 mg tid or 40 mg/kg/day) is treatment of choice for amoebic liver abscess. Metronidazole can be used intravenously, Tinidazole, (2 g daily orally for 3 days), secnidazole and ornidazole are other nitromidazole derivatives found to be effective in amoebic liver abscess. The second line alternative therapeutic drugs, i.e. dehydroemetine (1 mg/kg deep IM) and chloroquine 500 mg bid for 2 days and then 500 mg daily for 3 weeks should be reserved for nonresponders. South African and other studies done on liver abscesses have recommended an addition of luminal agent (diloxanide furoate 500 mg orally 3 times a day for 10 days) to metronidazole to eradicate cysts and prevent further transmission even if there is no evidence or past history of invasive amoebiasis.

Response to antiamoebic therapy is seen usually within 48-72 hours with prompt resolution of fever, pain, toxaemia, tender hepatomegaly; and therapy must be continued for 10 days. Relapses after adequate therapy are uncommon when a luminicidal agent has been added. Routine administration of antibiotics is not
indicated as superadded bacterial infection is not common.

3. Aspiration of the abscess: Routine aspiration of the abscess is not
indicated because it has been shown clearly that aspiration does not change the course of the disease as compared to medical therapy alone. Most of the patients respond to medical therapy. Aspiration is indicated in certain situations. Its distinction from pyogenic abscess is not easy. Patients with pyogenic liver abscess typically are older and have history of underlying bowel disease or recent surgery. There will be symptoms and sign of toxaemia. In pyogenic abscess sometimes, repeated aspiration of the amoebic liver abscess may lead to its conversion into pyogenic abscess, hence, repeated aspirations are to be avoided. Serial ultrasonographic follow up should be done to detect resolution of the abscess, which takes 3-6 months.

4. Catheter drainage: Along with medical therapy, aspiration with catheter may be required to treat abscess with complications (e.g. rupture).

5. Surgical exploration may become
necessary in certain situations like bowel perforation or rupture into the pericardium.

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