Amebic Hepatic Abscesses Medication

  • Author: Daniel Matei Brailita, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Nov 22, 2011
 

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.

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Amebicides

Class Summary

Used to eliminate the trophozoites of E histolytica in the liver and bowel wall.

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Metronidazole (Flagyl)

 

Oral synthetic antiprotozoal and antibacterial agent. Effectively eradicates amebic tissue infections, including liver abscess, but is only partially effective against luminal forms. Luminal amebicide also must be used to eradicate bowel luminal infection. Only effective against trophozoites and not cyst forms.

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Tinidazole (Tindamax, Fasigyn)

 

Nitroimidazole derivative used for susceptible protozoal infections. Eradicates amebic tissue infections, including liver abscess, but it is only partially effective against luminal forms. Luminal amebicide must also be used to eradicate bowel luminal infection. Only effective against trophozoites and not cyst forms.

Dehydroemetine (Dametine)

 

Preferred agent because it is less toxic than emetine. Eradicates amebic tissue infections, including liver abscess, but does not act on luminal forms. Luminal amebicide also must be used to eradicate the bowel luminal infection. Only effective against the trophozoite forms and not the cyst form. Available in US only from the Parasitic Disease Drug Service, Centers for Disease Control and Prevention (Atlanta, GA 30333; telephone: 404-639-3356).

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Ipecac syrup(Ipecac)

 

Eradicates amebic tissue infections, including liver abscess, but does not act on luminal forms. Luminal amebicide also must be used to eradicate the bowel luminal infection. Only effective against the trophozoite forms. Not available in US.

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Iodoquinol (Yodoxin)

 

Diiodohydroxyquin. Amebicidal against E histolytica and is considered effective against trophozoite and cyst forms. Used to eradicate concurrent intestinal amebiasis in order to prevent recurrence of hepatic amebiasis.

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Diloxanide (Entamide, Furamide)

 

Dichloroacetamide derivative. Amebicidal against trophozoite and cyst forms of E histolytica. Available in US only from the Parasitic Disease Drug Service, Centers for Disease Control and Prevention (Atlanta, GA 30333; telephone: 404-639-3356).

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Paromomycin (Humatin)

 

Amebicidal and antibacterial aminoglycoside active in intestinal amebiasis. Not significantly absorbed from GI tract. Amebicidal against luminal forms.

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Chloroquine (Aralen)

 

Inhibits growth by concentrating within acid vesicles of parasite, which increases internal pH of organism. Also inhibits hemoglobin utilization and metabolism of parasite. In vitro studies with trophozoites of E histolytica demonstrate that chloroquine possesses amebicidal activity comparable to that of emetine. Highly effective in treatment of amebic liver abscess when administered with emetine or dehydroemetine. Like emetine and dehydroemetine, it is not effective against luminal forms.

Irreversible retinal damage does not occur with dose and duration used for treatment of hepatic amebiasis.

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Contributor Information and Disclosures
Author

Daniel Matei Brailita, MD  Chief of Infectious Diseases, Mary Lanning Memorial Hospital

Daniel Matei Brailita, MD is a member of the following medical societies: HIV Medicine Association of America and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Ildiko Lingvay, MD, MPH  Assistant Professor, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Texas Southwestern Medical Center at Dallas

Ildiko Lingvay, MD, MPH is a member of the following medical societies: Endocrine Society and Texas Medical Association

Disclosure: Nothing to disclose.

KoKo Aung, MD, MPH, FACP  Associate Professor, Department of Medicine, University of Texas Health Science Center at San Antonio; Adjunct Associate Professor of Public Health, University of Texas School of Public Health

KoKo Aung, MD, MPH, FACP is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Ambrish Ojha, MD  Staff Physician, Department of Internal Medicine, Texas Tech University Health Sciences Center

Ambrish Ojha, MD is a member of the following medical societies: American College of Physicians and American Medical Association

Disclosure: Nothing to disclose.

Harvey Kantor, MD  Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Texas Tech University Health Science Center

Harvey Kantor, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Illinois State Medical Society, Infectious Diseases Society of America, New York Academy of Sciences, Royal Society of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert J Fingerote, MD, MSc, FRCPC  Consultant, Clinical Evaluation Division, Biologic and Gene Therapies, Directorate Health Canada; Consulting Staff, Department of Medicine, Division of Gastroenterology, York Central Hospital, Ontario

Robert J Fingerote, MD, MSc, FRCPC is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Oscar S Brann, MD, FACP  Associate Clinical Professor, Department of Medicine, University of California at San Diego; Consulting Staff, Mecklenburg Medical Group

Oscar S Brann, MD, FACP is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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CT scan of the abdomen with IV and oral contrast is shown. Note the thick-walled cavity with low attenuation center and contrast-enhanced periphery.
CT scan of the abdomen with contrast showing large amebic abscess with multiloculated appearance and atypical left liver lobe location. CT scan cannot differentiate amebic liver abscess from pyogenic liver abscess.
 
 
 
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