Treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound-guided needle aspiration: a comparative, prospective and randomized study.

Abstract	Thirty-nine patients with amoebic liver abscess (ALA), admitted to the Central Hospital of Hué (Vietnam), were evaluated in a comparative, prospective and randomized study for the treatment of ALA. Adult patients with an abscess located in the right liver lobe and an abscess diameter of 6 to 10 cm were included. Bacterial abscesses were excluded by microbiological examination of abscess fluid in all patients. Nineteen patients were treated with metronidazole for 10 days alone and 20 patients were punctured under ultrasound guidance with aspiration of abscess fluid in addition to drug administration. The clinical symptoms fever, pain in right upper abdomen and liver tenderness, and the laboratory parameters erythrocyte sedimentation rate, white blood cells, haemoglobin and C-reactive protein and the abscess size were determined on the day of admission and followed during an observation period of 38 days. Improvement of liver tenderness was significantly faster in the aspiration group during the first 3 days (P < 0.001), whereas all the other parameters showed no differences between the two groups. This minor benefit is obviously not sufficient to justify routine needle aspiration and advocates drug treatment alone for uncomplicated amoebic liver abscesses with a diameter up to 10 cm located in the right liver lobe.
Authors	Joerg Blessmann, Ho Duy Binh, Duong Manh Hung, Egbert Tannich, Gerd Burchard
Journal	Tropical medicine & international health : TM & IH (Trop Med Int Health) Vol. 8 Issue 11 Pg. 1030-4 (Nov 2003) ISSN: 1360-2276 [Print] England
PMID	14629771 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References	Anti-Infective Agents Metronidazole
Topics	Adolescent Adult Aged Aged, 80 and over Anti-Infective Agents (therapeutic use) Biopsy, Needle (methods) Combined Modality Therapy (methods) Female Humans Liver Abscess, Amebic (diagnostic imaging, drug therapy, surgery) Male Metronidazole (therapeutic use) Middle Aged Prospective Studies Treatment Outcome Ultrasonography

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