Amebiasis.

More than 80% of cases of amebic liver abscess can be managed with a 14-day course of intravenous or oral metronidazole. In cases of suspected amebic liver abscess, treatment should be started before diagnostic confirmation. If no clinical improvement is evident by 72 to 96 hours, treatment should be changed to dehydroemetine and chloroquine. Invasive treatment is necessary only in patients in whom medical treatment fails within 5 days or in whom signs of clinically severe disease are present. A 10-day course with a luminal agent such as paromomycin to eliminate intestinal cysts, which are resistant to imidazoles, should always follow treatment of the liver abscess. Percutaneous catheter drainage is indicated in patients with impending rupture, with a lesion 6 cm or more in diameter, with an abscess located in the left lobe or high in the dome of the right lobe, or in whom medical treatment fails. Although sympathetic pleural effusion is not an indication for drainage, direct pulmonary involvement or spread to pleural or lung tissues requires drainage. Intraperitoneal rupture and peritonitis necessitate open surgical drainage. Only a small minority of amebic liver abscesses are secondarily infected by other organisms. Because relapses are possible, feces should be checked for cysts monthly for several months after therapy.