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Amebiasis

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Opinion statement

  • More than 80% of cases of amebic liver abscess can be managed with a 14-day course of intravenous or oral metronidazole. In cases of suspected amebic liver abscess, treatment should be started before diagnostic confirmation.

  • If no clinical improvement is evident by 72 to 96 hours, treatment should be changed to dehydroemetine and chloroquine.

  • Invasive treatment is necessary only in patients in whom medical treatment fails within 5 days or in whom signs of clinically severe disease are present.

  • A 10-day course with a luminal agent such as paromomycin to eliminate intestinal cysts, which are resistant to imidazoles, should always follow treatment of the liver abscess.

  • Percutaneous catheter drainage is indicated in patients with impending rupture, with a lesion 6 cm or more in diameter, with an abscess located in the left lobe or high in the dome of the right lobe, or in whom medical treatment fails.

  • Although sympathetic pleural effusion is not an indication for drainage, direct pulmonary involvement or spread to pleural or lung tissues requires drainage.

  • Intraperitoneal rupture and peritonitis necessitate open surgical drainage.

  • Only a small minority of amebic liver abscesses are secondarily infected by other organisms.

  • Because relapses are possible, feces should be checked for cysts monthly for several months after therapy.

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Authors and Affiliations

  1. Center for Liver Diseases, University of Miami School of Medicine, 1500 NW 12th Avenue, Suite 1101, 33136, Miami, FL

    Salvatore Badalamenti MD, Jennifer E. Jameson BA & K. Rajender Reddy MD

Authors
  1. Salvatore Badalamenti MD
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  2. Jennifer E. Jameson BA
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  3. K. Rajender Reddy MD
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Badalamenti, S., Jameson, J.E. & Reddy, K.R. Amebiasis. Curr Treat Options Gastro 2, 97–103 (1999). https://doi.org/10.1007/s11938-999-0036-z

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  • DOI: https://doi.org/10.1007/s11938-999-0036-z

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