Amebic liver abscess: An update

Table 1 Randomised studies comparing treatment of amebic liver abscess patients with or without percutaneous aspiration

Ref./country	Treatment groups (n)	ALA size/volume (cm/mL)	Normalization of fever	Reduction of pain and/or local tenderness	Resolution in abscess size	TLC decline	Length of hospital stay
Sharma et al[98], India	MTZ (n = 20) and MTZ + PD (n = 19)	7.2 ± 0.20 cm and 5.4 ± 2.2 cm	Similar on day (84 vs 94%)	Similar on day 10 (67% vs 58%)	No significant change at day 10	Similar between the groups	NA
Blessmann et al[99], Germany	MTZ (n = 19) and MTZ + PD (n = 20)	169 ± 90 mL and 161 ± 49 mL	100% at day 6 in both groups	Significantly better at day 3 in MTZ + PD group: (60% vs 5%, P = 0.001)	Greater reduction in MTZ + PD at day 10 (109 mL vs 64 mL, P = 0.02)	Similar between groups	NA
Van Allan et al[94], United States	MTZ (n = 21) and MTZ + PD (n = 20)	8.5 ± 3.5 cm and 7.5 ± 2.4 cm	Similar between groups (3 d vs 4 d, P = 0.5)	Early reduction in MTZ + PD group (3 d vs 1 d, P = 0.05)	NA	NA	Similar between groups (5 d vs 6.2 d, P = 0.19)
Ghosh et al[95], India	MTZ (n = 98) and MTZ + PD (n = 96)	6.8 ± 2.6 cm and 6.8 ± 2.6 cm	Better at day 8 in MTZ + PD group (P < 0.001)	Significantly better at day 3 in MTZ + PD group (P = 0.03)	Greater reduction in MTZ + PD (P = 0.003)	Better in MTZ + PD at day 8 (P < 0.001)	NA
Freeman et al[93], Nigeria	MTZ (n = 17) and MTZ + PD (n = 19)	1.5 to 14.5 cm and 1.5 to 14.5 cm	Similar between groups at week-3 (19/19 vs 16/17)	Similar between groups at week-3	Greater reduction in MTZ + PD when ALA > 6 cm (P = 0.005)	NA	NA
Bammigatti et al[100], India	MTZ (n = 29) and MTZ + PD (n = 28)	148.4 ± 103 mL and 211.5 ± 119 mL	Similar between groups (30 h vs 17 h, P = 0.48)	Median time similar between groups (48 h vs 27 h, P = 0.16)	NA	Shorter in MTZ + PD group (2.4 d vs 3.7 d, P = 0.05)	Similar between groups (4.5 d vs 4.4 d, P = 0.62)
Widjaya et al[96], Indonesia	MTZ (n = 16) and MTZ + PD (n = 17)	NA	NA	NA	Shorter duration of abscess resolution in M + PA group	NA	NA
Tandon et al[92], India	MTZ (n = 14) and MTZ + PD (n = 15)	> 5 cm	Better in MTZ + PD group (5.6 d vs 3.8 d; P < 0.05)	Better in MTZ + PD group (P < 0.001)	NA	Similar between groups	Shorter in MTZ + PD group (7.4 vs 5.8, P < 0.001)
de la Rey Nel et al[97], South Africa	MTZ (n = 43) and MTZ + PD (n = 37)	NA	Similar between groups (P > 0.05)	Better in MTZ + PD group (6.9 ± 2.3 vs 4.5 ± 2.2, P < 0.05)	No significant difference between groups	NA	NA

ALA: Amebic liver abscess; PD: Percutaneous drainage; MTZ: Metronidazole; TLC: Total leukocyte count; NA: Not available (data).

Table 2 Mortality rates of surgical versus non-surgical therapy in patients with amebic liver abscess with diffuse peritoneal rupture

Ref.	n	Medical therapy (n)	Surgery (n)	Medical therapy1	Surgery
				Mortality (%)	Mortality (%)
Eggleston et al[104]	19	0	19	-	42
Memon et al[106]	36	20	16	5	37.5
Sarda et al[107]	16	8	8	0	50
Meng et al[40]	11	1	10	0	50
Baijal et al[108]	02	2	-	0	-
Bhatia et al[109]	43	43	0	-	26
Priyadarshi et al[19]	32	32	0	0.3	-
Greaney et al[105]2	08	3	5	0	20

¹Medical therapy included anti-amebic treatment along with percutaneous catheter drainage, with exception of one study.

²In which percutaneous drainage was not performed.