Amoebic liver abscess medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Indications for medical management of amoebic liver abscess are all non-complicated [[abscess|abscesses]], without compression effect, and without features of rupture or impending rupture. Treatment of [[intraluminal]] infection include [[iodoquinol]], [[metronidazole]], [[tinidazole]], and [[paromomycin]].<ref name="pmid10524950">{{cite journal| author=Petri WA, Singh U| title=Diagnosis and management of amebiasis. | journal=Clin Infect Dis | year= 1999 | volume= 29 | issue= 5 | pages= 1117-25 | pmid=10524950 | doi=10.1086/313493 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10524950 }} </ref> | |||
==Medical Therapy== | ==Medical Therapy== | ||
The four main groups of treatment modalities effective in the treatment of amoebic liver abscess include: | 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 | *[[Drug therapy]] only | ||
*Ultrasound guided aspiration and drug therapy only | *[[Ultrasound]] guided aspiration and drug therapy only | ||
*Percutaneous catheter drainage and drug therapy | *[[Percutaneous]] catheter drainage and drug therapy | ||
*Laparotomy, drainage, and drug therapy | *[[Laparotomy]], drainage, and drug therapy | ||
Indications for medical management: | Indications for medical management: | ||
*All non-complicated abscesses | *All non-complicated abscesses | ||
* | *Without compression effect | ||
* | *Without features of rupture or impending rupture | ||
Pharmacotherapy for ''[[Entamoeba|E histolytica]]'' include: | Pharmacotherapy for ''[[Entamoeba|E histolytica]]'' include: | ||
| Line 25: | Line 23: | ||
!Treatment | !Treatment | ||
|- | |- | ||
!Intraluminal infection | ![[Intraluminal|Intralumina]]<nowiki/>l infection | ||
|Iodoquinol 650mg tid X 20 days <br> Diloxanide furoate 500mg tid X 20 days<br> | |[[Iodoquinol]] 650mg tid X 20 days <br> [[Diloxanide furoate]] 500mg tid X 20 days<br>[[Paromomycin]] 30mg/kg/day X 10 days (in 3 divided doses) | ||
|- | |- | ||
!Amoebic liver abscess | !Amoebic liver abscess | ||
|Metronidazole 800mg tid PO X 10days (500mg qid IV) | |[[Metronidazole]] 800mg tid PO X 10days (500mg qid IV) | ||
|- | |- | ||
!Invasive colitis | !Invasive colitis | ||
|Metronidazole 800mg tid X 5 days<br> Tinidazole 1 gm bd X 3 days | |[[Metronidazole]] 800mg tid X 5 days<br> [[Tinidazole]] 1 gm bd X 3 days | ||
|} | |} | ||
Current treatment recommendations of ''[[Entamoeba|E histolytica]]'' includes | Current treatment recommendations of ''[[Entamoeba|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.<ref name="pmid10524950">{{cite journal| author=Petri WA, Singh U| title=Diagnosis and management of amebiasis. | journal=Clin Infect Dis | year= 1999 | volume= 29 | issue= 5 | pages= 1117-25 | pmid=10524950 | doi=10.1086/313493 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10524950 }} </ref> | * 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.<ref name="pmid10524950">{{cite journal| author=Petri WA, Singh U| title=Diagnosis and management of amebiasis. | journal=Clin Infect Dis | year= 1999 | volume= 29 | issue= 5 | pages= 1117-25 | pmid=10524950 | doi=10.1086/313493 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10524950 }} </ref> | ||
*Pharmacotherapy is the first line treatment for amoebic liver abscess | *Pharmacotherapy is the first line treatment for amoebic liver abscess | ||
{| class="wikitable" | {| class="wikitable" | ||
| Line 45: | Line 43: | ||
|- | |- | ||
| rowspan="2" |Initial treatment of amoebic liver abscess | | rowspan="2" |Initial treatment of amoebic liver abscess | ||
|Metronidazole | |[[Metronidazole]] | ||
|750 mg PO TID × 7–10 days | |750 mg PO TID × 7–10 days | ||
|35–50 mg/kg/day | |35–50 mg/kg/day divided TID × 7–10 days | ||
|- | |- | ||
|Tinidazole | |[[Tinidazole]] | ||
|2 g once PO daily × 3 days | |2 g once PO daily × 3 days | ||
|>3 years: 50 mg/kg/day (max 2 g) PO in 1 dose × 3 days | |>3 years: 50 mg/kg/day (max 2 g) PO in 1 dose × 3 days | ||
|- | |- | ||
| rowspan="2" |Clearance of luminal cysts | | rowspan="2" |Clearance of luminal cysts | ||
|Iodoquinol | |[[Iodoquinol]] | ||
|650 mg PO TID × 20 days | |650 mg PO TID × 20 days | ||
|30–40 mg/kg/day | |30–40 mg/kg/day divided TID × 20 days (max 2 g/day) | ||
|- | |- | ||
|Paromomycin | |[[Paromomycin]] | ||
|500 mg PO TID × 7 days OR | |500 mg PO TID × 7 days OR | ||
25–35 mg/kg/day | 25–35 mg/kg/day divided TID × 7 days | ||
|25–35 mg/kg/day | |25–35 mg/kg/day divided TID × 7 days | ||
|} | |} | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Surgery]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Infectious disease]] | |||
[[Category:Hepatology]] | |||
Latest revision as of 20:23, 29 July 2020
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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.[1]
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
- ↑ 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.