Amebic Liver/Hepatic Abscesses Medication

Updated: Mar 07, 2017
  • Author: Daniel Matei Brailita, MD; Chief Editor: BS Anand, MD  more...
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Medication

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.

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.

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).

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.

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.

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).

Paromomycin (Humatin)

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

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 the 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 the dose and duration used for the treatment of hepatic amebiasis.

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