Microscopic examination of three stool samples, often combined with serologic testing, remains the standard diagnostic approach.
- Up to 10% of pts with acute amebic liver abscess may have negative serologies; testing should be repeated in 1 week if clinical suspicion remains high.
Treatment: Amebiasis - Tinidazole (2 g/d PO for 3 days) or metronidazole (750 mg PO or IV tid for 5-10 days) is recommended for amebic colitis and amebic liver abscess.
- - Within 3 days of treatment initiation, >90% of pts respond clinically.
- - Drainage of liver abscesses is rarely needed. Indications for aspiration include the need to rule out pyogenic abscess, a lack of response to treatment in 3-5 days, an imminent threat of liver-abscess rupture, or the need to prevent left-lobe abscess rupture into the pericardium.
- Pts with either colitis or liver abscesses should also receive a luminal agent to ensure eradication of the infection. Paromomycin (500 mg PO tid for 10 days) is the preferred agent; iodoquinol (650 mg PO tid for 20 days) is an alternative.
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