Amebic Liver Abscess (Liver Abscess)

Amebic Liver Abscess (ALA) – Treatment Overview

Introduction
Amebic liver abscess (ALA) is the most common extraintestinal manifestation of Entamoeba histolytica infection. It occurs when trophozoites invade the colonic mucosa, enter the portal circulation, and localize in the liver, leading to hepatic necrosis and abscess formation. Typical presentation includes fever, right upper quadrant pain, hepatomegaly, and tender liver, sometimes with referred shoulder pain. Without treatment, ALA may rupture into the pleural, pericardial, or peritoneal spaces, causing life-threatening complications.

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Treatment Options and Doses

1. Tissue-Active Agents (to eliminate invasive trophozoites)

• Metronidazole (drug of choice):

  • Adults: 750 mg orally or IV three times daily for 7–10 days.

  • Children: 35–50 mg/kg/day orally in 3 divided doses (max 2.25 g/day) for 7–10 days.

• Tinidazole (alternative):

  • Adults: 2 g orally once daily for 5 days.

  • Children: 50 mg/kg once daily (max 2 g/day) for 5 days.

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2. Luminal Agents (to eradicate intestinal cysts and prevent recurrence)
Always given after metronidazole or tinidazole to clear intraluminal cysts. Options:

• Paromomycin: 25–35 mg/kg/day orally in 3 divided doses for 7 days.

• Iodoquinol: 650 mg orally three times daily for 20 days.

• Diloxanide furoate: 500 mg orally three times daily for 10 days (if available).

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3. Drainage of Abscess (selected cases only)

• Most abscesses respond to drug therapy alone.

• Indications for aspiration/drainage:

  • Impending rupture (large left lobe abscess at risk of pericardial rupture).

  • Poor response to medical therapy within 5–7 days.

  • Uncertain diagnosis (to differentiate from pyogenic abscess or tumor).

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4. Supportive Measures

• Adequate hydration and nutritional support.

• Analgesics for pain relief (e.g., paracetamol).

• Broad-spectrum antibiotics only if secondary bacterial infection is suspected.