علاج خراج الكبد الأميبي غير المعقد بحجم خراج أقل من 5 سم أو 5–10 سم

DOI: 10.4254/wjh.v16.i3.316

• For uncomplicated amebic liver abscess (ALA): Upfront percutaneous drainage (PD) should be considered only in the presence of high risk signs; PD doesn't provide added benefit when ALA size is < 5 cm, and ALA with size > 5 should be treated initially with medical therapy (MT) consisting of anti-amebic drug for 3-5 d before considering PD in case of non-response.
• Thus, a conservative strategy should be adopted for most patients with uncomplicated ALA.
• MTZ has a good hepatic penetration, and when used at a dose of 500 mg to 750 mg three times a day for seven to ten days, it resolves symptoms within 72 h of treatment.
• Since the parasites can linger in the colon, MTZ treatment should be followed with a luminal agent, such as paromomycin (500 mg 3 times a day for 7 d) or diloxanide furoate (500 mg three times a day for 20 d).
• In a small study, 2 g tinidazole once daily for 2 d resulted in completed recovery of ALA in all (n = 10) subjects.
• In a recent randomized controlled trial (RCT), nitazoxanide, at 500 mg twice daily for 10 d, was found more tolerable and as effective as MTZ in uncomplicated ALA patients.