Amebic Hepatic Abscesses Medication
- Author: Daniel Matei Brailita, MD; Chief Editor: BS Anand, MD more...
The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.
Used to eliminate the trophozoites of E histolytica in the liver and bowel wall.
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.
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.
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).
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.
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.
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).
Amebicidal and antibacterial aminoglycoside active in intestinal amebiasis. Not significantly absorbed from GI tract. Amebicidal against luminal forms.
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.
Blazquez S, Rigothier MC, Huerre M, et al. Initiation of inflammation and cell death during liver abscess formation by Entamoeba histolytica depends on activity of the galactose/N-acetyl-D-galactosamine lectin. Int J Parasitol. 2007 Mar. 37(3-4):425-33. [Medline].
Stanley SL Jr. Amoebiasis. Lancet. 2003 Mar 22. 361(9362):1025-34. [Medline].
Acuna-Soto R, Maguire JH, Wirth DF. Gender distribution in asymptomatic and invasive amebiasis. Am J Gastroenterol. 2000 May. 95(5):1277-83. [Medline].
Blessmann J, Ali IK, Nu PA, et al. Longitudinal study of intestinal Entamoeba histolytica infections in asymptomatic adult carriers. J Clin Microbiol. 2003 Oct. 41(10):4745-50. [Medline].
Haque R, Duggal P, Ali IM, et al. Innate and acquired resistance to amebiasis in bangladeshi children. J Infect Dis. 2002 Aug 15. 186(4):547-52. [Medline].
Hoffner RJ, Kilaghbian T, Esekogwu VI, et al. Common presentations of amebic liver abscess. Ann Emerg Med. 1999 Sep. 34(3):351-5. [Medline].
Hughes MA, Petri WA Jr. Amebic liver abscess. Infect Dis Clin North Am. 2000 Sep. 14(3):565-82, viii. [Medline].
Ravdin JI. Amebiasis. Clin Infect Dis. 1995 Jun. 20(6):1453-64; quiz 1465-6. [Medline].
Ravdin JI, Stauffer W. Entamoeba histolytica (amebiasis). Mandell Gl, Bennett J, Dolin R eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, PA: Elsevier; 2005. Vol 2: Part III, sect H, 3097-3111.
Mbaye PS, Koffi N, Camara P, et al. [Pleuropulmonary manifestations of amebiasis]. Rev Pneumol Clin. 1998 Dec. 54(6):346-52. [Medline].
Tanyuksel M, Petri WA Jr. Laboratory diagnosis of amebiasis. Clin Microbiol Rev. 2003 Oct. 16(4):713-29. [Medline].
Solaymani-Mohammadi S, Rezaian M, Babaei Z, et al. Comparison of a stool antigen detection kit and PCR for diagnosis of Entamoeba histolytica and Entamoeba dispar infections in asymptomatic cyst passers in Iran. J Clin Microbiol. 2006 Jun. 44(6):2258-61. [Medline].
Hamzah Z, Petmitr S, Mungthin M, et al. Differential detection of Entamoeba histolytica, Entamoeba dispar, and Entamoeba moshkovskii by a single-round PCR assay. J Clin Microbiol. 2006 Sep. 44(9):3196-200. [Medline].
Khairnar K, Parija SC. A novel nested multiplex polymerase chain reaction (PCR) assay for differential detection of Entamoeba histolytica, E. moshkovskii and E. dispar DNA in stool samples. BMC Microbiol. 2007 May 24. 7:47. [Medline].
Roy S, Kabir M, Mondal D, et al. Real-time-PCR assay for diagnosis of Entamoeba histolytica infection. J Clin Microbiol. 2005 May. 43(5):2168-72. [Medline].
Qvarnstrom Y, James C, Xayavong M, et al. Comparison of real-time PCR protocols for differential laboratory diagnosis of amebiasis. J Clin Microbiol. 2005 Nov. 43(11):5491-7. [Medline].
Otto MP, Gerome P, Rapp C, et al. False-negative serologies in amebic liver abscess: report of two cases. J Travel Med. 2013 Mar-Apr. 20(2):131-3. [Medline].
Knobloch J, Mannweiler E. Development and persistence of antibodies to Entamoeba histolytica in patients with amebic liver abscess. Analysis of 216 cases. Am J Trop Med Hyg. 1983 Jul. 32(4):727-32. [Medline].
Restrepo MI, Restrepo Z, Elsa Villareal CL, et al. Diagnostic tests for amoebic liver abscess: comparison of enzyme-linked immunosorbent assay (ELISA) and counterimmunoelectrophoresis (CIE). Rev Soc Bras Med Trop. 1996 Jan-Feb. 29(1):27-32. [Medline].
Leo M, Haque R, Kabir M, et al. Evaluation of Entamoeba histolytica antigen and antibody point-of-care tests for the rapid diagnosis of amebiasis. J Clin Microbiol. 2006 Dec. 44(12):4569-71. [Medline].
Bammigatti C, Ramasubramanian N, Kadhiravan T, Das AK. Percutaneous needle aspiration in uncomplicated amebic liver abscess: a randomized trial. Trop Doct. 2013 Jan. 43(1):19-22. [Medline].
Khan U, Mirdha BR, Samantaray JC, et al. Detection of Entamoeba histolytica using polymerase chain reaction in pus samples from amebic liver abscess. Indian J Gastroenterol. 2006 Mar-Apr. 25(2):55-7. [Medline].
Singh P, Mirdha BR, Ahuja V, Singh S. Evaluation of small-subunit rRNA touchdown polymerase chain reaction for direct detection of Entamoeba histolytica in human pus samples from patients with amoebic liver abscess. Indian J Med Microbiol. 2011 Apr-Jun. 29(2):141-6. [Medline].
Khan R, Hamid S, Abid S, et al. Predictive factors for early aspiration in liver abscess. World J Gastroenterol. 2008 Apr 7. 14(13):2089-93. [Medline].
Khanna S, Chaudhary D, Kumar A, et al. Experience with aspiration in cases of amebic liver abscess in an endemic area. Eur J Clin Microbiol Infect Dis. 2005 Jun. 24(6):428-30. [Medline].
Blessmann J, Binh HD, Hung DM, et al. Treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound-guided needle aspiration: a comparative, prospective and randomized study. Trop Med Int Health. 2003 Nov. 8(11):1030-4. [Medline].
Maltz G, Knauer CM. Amebic liver abscess: a 15-year experience. Am J Gastroenterol. 1991 Jun. 86(6):704-10. [Medline].
Rajak CL, Gupta S, Jain S, et al. Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage. AJR Am J Roentgenol. 1998 Apr. 170(4):1035-9. [Medline].
Stanley SL Jr. Vaccines for amoebiasis: barriers and opportunities. Parasitology. 2006. 133 Suppl:S81-6. [Medline].
Snow MJ, Stanley SL Jr. Recent progress in vaccines for amebiasis. Arch Med Res. 2006 Feb. 37(2):280-7. [Medline].
Houpt E, Barroso L, Lockhart L, et al. Prevention of intestinal amebiasis by vaccination with the Entamoeba histolytica Gal/GalNac lectin. Vaccine. 2004 Jan 26. 22(5-6):611-7. [Medline].
Abd Alla MD, White GL, Rogers TB, et al. Adherence-inhibitory intestinal immunoglobulin a antibody response in baboons elicited by use of a synthetic intranasal lectin-based amebiasis subunit vaccine. Infect Immun. 2007 Aug. 75(8):3812-22. [Medline].
Ivory CP, Chadee K. Intranasal immunization with Gal-inhibitable lectin plus an adjuvant of CpG oligodeoxynucleotides protects against Entamoeba histolytica challenge. Infect Immun. 2007 Oct. 75(10):4917-22. [Medline].
Stanley SL Jr, Jackson TF, Foster L, et al. Longitudinal study of the antibody response to recombinant Entamoeba histolytica antigens in patients with amebic liver abscess. Am J Trop Med Hyg. 1998 Apr. 58(4):414-6. [Medline].