Recommendations
| Дозування | Ремарки | |
|---|---|---|
|
metronidazole oral 750 mg three times daily for 7 to 10 days
|
Start treatment with |
|
|
clioquinol oral 250 mg three times daily for 10 days
|
...immediately followed by contact-amoebicide treatment 1st choice |
|
|
paromomycin oral 500 mg three times daily for 7 days
|
...immediately followed by contact-amoebicide treatment 2nd choice |
Percutaneous aspiration under radiological guidance plus metronidazole offers no advantage over metronidazole alone in uncomplicated amoebic liver abscess. Consider aspiration if the diagnosis is uncertain (e.g. serology not conclusive or not available) or in case of impending perforation. Predictors for the need for aspiration: 1) abscess size > 10 cm; 2) involvement of both lobes of the liver or an abscess in the left lobe of the liver; 3) failure of medical treatment.
Metronidazole should not be taken together with alcoholic beverages.
The use of clioquinol during pregnancy and lactation is not recommended. Clioquinol contains iodine which can be taken up by the foetal thyroid. It may also affect the thyroid function of the infant during lactation.
At a (cumulative) dose of 10–50 grams of clioquinol there is an increased risk of neurotoxicity, which is why it is recommended not to administer clioquinol at high doses over a short period. For repeated treatment, three courses per year with several months in between are recommended.
Entamoeba dispar (non-pathogenic): no treatment.
Paromomycin is not registered in the Netherlands but is a so-called "ZFW-medicine". Within ZFW medicines paromomycin is not registered for this indication and is therefore not reimbursed.