OBJECTIVE: To determine the value of needle aspiration in uncomplicated amoebic liver abscess. DESIGN: Randomised case-control study with a minimum follow up of one year, comparing patients treated with drugs alone with those treated with additional needle aspiration. SETTING: Referral based gastroenterology clinic. PATIENTS: 39 Consecutive patients with amoebic liver abscess in the right lobe, of whom 37 completed the study. INTERVENTION: Metronidazole 2.4 g/day was given to all patients for 10 days. Needle aspiration of the abscess was performed in 19 patients on the day of admission to hospital. MAIN OUTCOME MEASURES: Abdominal pain, fever, anorexia, and hepatomegaly were measured. Erythrocyte sedimentation rate, serum aspartate, and alanine aminotransferase activities, and alkaline phosphatase activity were also measured. RESULTS: Clinical improvement was similar in both groups of patients. Improvement in haematological and biochemical variables and rates of healing of cavities were also similar. CONCLUSIONS:Chemotherapy with potent tissue amoebicidal drugs such as metronidazole is optimally effective in treating amoebic liver abscess, and in uncomplicated cases routine aspiration is not required.
RCT Entities:
OBJECTIVE: To determine the value of needle aspiration in uncomplicated amoebic liver abscess. DESIGN: Randomised case-control study with a minimum follow up of one year, comparing patients treated with drugs alone with those treated with additional needle aspiration. SETTING: Referral based gastroenterology clinic. PATIENTS: 39 Consecutive patients with amoebic liver abscess in the right lobe, of whom 37 completed the study. INTERVENTION: Metronidazole 2.4 g/day was given to all patients for 10 days. Needle aspiration of the abscess was performed in 19 patients on the day of admission to hospital. MAIN OUTCOME MEASURES: Abdominal pain, fever, anorexia, and hepatomegaly were measured. Erythrocyte sedimentation rate, serum aspartate, and alanine aminotransferase activities, and alkaline phosphatase activity were also measured. RESULTS: Clinical improvement was similar in both groups of patients. Improvement in haematological and biochemical variables and rates of healing of cavities were also similar. CONCLUSIONS: Chemotherapy with potent tissue amoebicidal drugs such as metronidazole is optimally effective in treating amoebic liver abscess, and in uncomplicated cases routine aspiration is not required.
Authors: Alicia Hidron; Nicholas Vogenthaler; José I Santos-Preciado; Alfonso J Rodriguez-Morales; Carlos Franco-Paredes; Anis Rassi Journal: Clin Microbiol Rev Date: 2010-04 Impact factor: 26.132