Clinical Evaluation of Metronidazole in Hepatic Amebiasis

Abstract

Metronidazole (Flagyl®) was used to treat 25 patients with hepatomegaly associated with intestinal infection with Entamoeba histolytica. Seven patients had amebic abscess of the liver, two of whom also had pulmonary amebiasis. The dosage used was 200 mg of the drug three times daily for 7 days. Response to treatment was rapid: malaise, fever, and abdominal pain were relieved after 3 days, and in most patients disappeared after 6 days of therapy. Hepatic tenderness disappeared in all patients after 3 days. Hepatomegaly regressed rapidly in all patients but did not disappear in 3 weeks in some patients. Both patients with pulmonary amebiasis improved, but in one this was transitory. There was parasitologic cure in 22 patients at the end of 3 weeks, which lasted for a further 12 weeks after treatment began, but cysts persisted in three patients. The drug was well-tolerated. Side-effects (anorexia, nausea, coated tongue, and dizziness) were mild, did not require interruption of treatment, and disappeared within 2 days after completion of therapy. We concluded that this low-dosage regime is as effective for the treatment of hepatic amebiasis as the larger doses that have been employed.