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Evidence summaries

Image-Guided Percutaneous Procedure Plus Metronidazole Versus Metronidazole Alone for Uncomplicated Amoebic Liver Abscess

Therapeutic percutaneous needle aspiration in addition to metronidazole might possibly reduce pain and tenderness but not to to hasten clinical or radiologic resolution compared to metronidazole alone in uncomplicated amoebic liver abscesses although the evidence is insufficient. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 7 studies with a total of 310 subjects. Pooled analysis of 3 homogenous trials showed that needle aspiration did not significantly increase the proportion of patients with fever resolution (RR 0.60, 95% CI 0.22 to 1.61). Trials that evaluated resolution of abdominal pain, days to resolution of fever, pain, resolution of abscess cavities, reduction in liver size, and duration of hospitalisation were heterogeneous. Aspiration in addition to metronidazole resulted in better results concerning the number of days to resolution of pain (MD -1.59, 95%CI -2.73 to -0.42), number of days to resolution of abdominal tenderness (MD -1.70, 95%CI -2.86 to -0.54), and duration of hospitalisation (MD -1.31, 95%CI -2.05 to -0.57) compared to metronidazole alone.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and unclear blinding), by inconsistency (variability in results across studies) and by imprecise results (few patients and wide confidence intervals).

    References

    • Chavez-Tapia NC, Hernandez-Calleros J, Tellez-Avila FI, Torre A, Uribe M. Image-guided percutaneous procedure plus metronidazole versus metronidazole alone for uncomplicated amoebic liver abscess. Cochrane Database Syst Rev 2009 Jan 21;(1):CD004886. [PubMed]

Primary/Secondary Keywords