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).
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