title: Amoebic liver abscess: the effect of aspiration on the resolution or healing time. Ultrasound-guided needle aspiration of amoebic liver abscess. Amoebic liver abscess: ultrasonographic characteristics and results of different therapeutic approaches. Needle aspiration of amoebic liver abscess. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. Comparative study of catheter drainage and needle aspiration in management of large liver abscesses Uncomplicated amebic liver abscess: prospective evaluation of percutaneous therapeutic aspiration. Treatment of liver abscess: prospective randomized comparison of catheter drainage and needle aspiration Treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound-guided needle aspiration: a comparative, prospective and randomized study. Percutaneous needle aspiration in uncomplicated amebic liver abscess: a randomized trial Efficacy of aspiration in amebic liver abscess. Randomized clinical trials in HEPATOLOGY: predictors of quality. Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Management of large amoebic liver abscess--a comparative study of needle aspiration and catheter drainage. Needle aspiration in large amoebic liver abscess. Long term follow-up of amebic liver abscess: clinical and ultrasound patterns of resolution. Indications for aspiration of amoebic liver abscess. Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage. Comparative study of tinidazole and metronidazole in amoebic liver abscess. Treatment of Amoebic Liver Abscess with Tinidazole and Metronidazole Comparative study of tinidazole versus metronidazole in treatment of amebic liver abscess: A randomized control trial
abstract: Recent sonographic monitoring of patients treated for amoebic liver abscess has shown the healing or resolution time varying between 10 and 300 days . The effect of percutaneous needle aspiration under or resolution time was studied in 36 patients . Nineteen patients had drugs and needle aspiration under ultrasound guide whilst the 17 patients had drugs -- metronidazole , diloxanide , and chloroquine -- alone . Both groups were monitored clinical ly and sonographically . Results showed that the abscess cavities of 18 out of 19 patients ( 94.7 % ) of the aspirated group and 10 of 17 patients ( 58.8 % ) of the non-aspirated group had resolved at the end of three weeks . The difference in response to treatment was significant ( P less than 0.02 ) more so for lesion size more than 6 cm ( P less than 0.01 ) . There was also a more rapid clinical response in the aspirated group than in the non-aspirated group , particularly for patients whose lesion size was more than 6 cm ( P less than 0.01 ) . In conclusion , percutaneous needle aspiration is safe , enhances clinical recovery , and accelerates resolution particularly in patients with large abscess cavities This prospect i ve study was carried out on 200 patients with clinical ly , ultrasonographically and serologically confirmed amoebic liver abscess . The role of ultrasound-guided needle aspiration in addition to medications was evaluated compared to drug treatment alone . Both the groups were monitored clinical ly and sonographically for up to 6 months after diagnosis . The initial response ( after 15 days ) was better in the aspirated group ( P < 0.05 ) but resolution of abscess after 6 months were similar . There was a more rapid clinical response in the aspirated group , particularly in those with larger ( > 6 cm ) abscesses and there were no complications . Percutaneous ultrasound-guided needle aspiration is a safe diagnostic and therapeutic approach which enhances clinical recovery , accelerates resolution , especially in large abscesses , and prevents complications This prospect i ve study was carried out on 33 patients with clinical ly , serologically and ultrasonographically confirmed amoebic liver abscess . All patients were r and omly treated with metronidazole and chlorochin or a combination of medicamentous therapy and percutaneous drainage .  Ultrasonographic characteristics of amoebic liver abscesses were rotound or oval shape , usually hypoechogenic content with specific dorsal sonic enhancement , and in the majority of cases , location near liver capsule . Shorter duration of amoebic liver abscess resolution time in the group of patients treated with the combined therapy was observed particularly in the first four weeks of the treatment . The authors concluded that percutaneous drainage in combination with medicamentous therapy represents a successful therapeutic approach in the treatment of amoebic liver abscesses OBJECTIVE --To determine the value of needle aspiration in uncomplicated amoebic liver abscess . DESIGN --R and omised case-control study with a minimum follow up of one year , comparing patients treated with drugs alone with those treated with additional needle aspiration . SETTING --Referral based gastroenterology clinic . PATIENTS --39 Consecutive patients with amoebic liver abscess in the right lobe , of whom 37 completed the study . INTERVENTION -- Metronidazole 2.4 g/day was given to all patients for 10 days . Needle aspiration of the abscess was performed in 19 patients on the day of admission to hospital . MAIN OUTCOME MEASURES --Abdominal pain , fever , anorexia , and hepatomegaly were measured . Erythrocyte sedimentation rate , serum aspartate , and alanine aminotransferase activities , and alkaline phosphatase activity were also measured . RESULTS -- Clinical improvement was similar in both groups of patients . Improvement in haematological and biochemical variables and rates of healing of cavities were also similar . CONCLUSIONS --Chemotherapy with potent tissue amoebicidal drugs such as metronidazole is optimally effective in treating amoebic liver abscess , and in uncomplicated cases routine aspiration is not required OBJECTIVE The purpose of this study was to determine the effectiveness of percutaneous catheter drainage ( PCD ) and to compare PCD with percutaneous needle aspiration in the management of liver abscess . SUBJECTS AND METHODS Sixty patients with pyogenic liver abscess were r and omly assigned to two groups in a prospect i ve study . Antibiotics were administered for 10 days , starting the day of the beginning of percutaneous treatment . One group was treated with sonographically guided PCD and the other group with repeated percutaneous needle aspiration . Percutaneous needle aspiration was attempted a maximum of three times . Lack of response to the third aspiration was considered failure of treatment ; these patients were treated with PCD but were not included in the PCD group for analysis . Patient demographics , duration of hospital stay , treatment outcome , and complications were analyzed . RESULTS Percutaneous needle aspiration was successful in 20 ( 67 % ) of the 30 patients after one ( n = 12 ) , two ( n = 7 ) , or three ( n = 1 ) aspirations . PCD was curative in all 30 patients after one ( n = 24 ) or two ( n = 6 ) procedures . All abscesses 50 mm or less in longest diameter were successfully managed , 10 by percutaneous needle aspiration and 12 by PCD . None of patients in the percutaneous needle aspiration group with multiloculated abscesses ( n = 5 ) was successfully treated . Hospital stay did not differ significantly between the groups . There were no complications related to the procedure . CONCLUSION PCD is more effective than percutaneous needle aspiration in the management of liver abscess . Percutaneous needle aspiration can be used as a valid alternative for simple abscesses 50 mm in diameter or smaller Objective To compare the effectiveness of percutaneous catheter drainage ( PCD ) and percutaneous needle aspiration ( PNA ) in the management of large ( > 10 cm diameter ) liver abscesses . Methods Seventy-two patients with liver abscess ( amebic 48 , pyogenic 24 ) were r and omly allocated to PCD or PNA ( 36 each ) , which were done within 24 hours of admission . Both groups received parenteral antibiotics for at least 10 days . PNA was repeated every third day if the cavity size had not declined to 50 % of the original for up to three times . Persistence of cavity or of clinical symptoms was considered failure of treatment . Duration to attain clinical relief , duration of hospital stay , complications , treatment failure , and deaths were recorded . Results PNA was successful in 31 of 36 ( 86 % ) patients ( one aspiration in 10 , two in 18 , and three in 3 patients ) , whereas PCD was successful in 35 ( 97 % ) patients ( p = ns ) . Duration to attain clinical relief ( 10.2 [ 2.0 ] vs. 8.1 [ 2.7 ] days ; p=0.02 ) and parenteral antibiotics needed ( 15.5 [ 1.1 ] vs. 10.9 [ 2.7 ] days ; p=0.04 ) were significantly lower in PCD group . Duration of hospital stay was similar in the two groups . One patient with PNA had a subcapsular hematoma and one with PCD had continuous bile leakage which stopped spontaneously . One patient in PCD group died . Conclusion PCD is a better treatment option than PNA for the management of large liver abscesses of size > 10 cm , in terms of duration to attain clinical relief and duration for which parenteral antibiotics are needed The performance of therapeutic aspiration in the treatment of amebic liver abscess , advocated and practice d in many centers , is controversial . Previously , this practice has been evaluated in retrospective analyses . To test the potential benefit of therapeutic aspiration , the authors undertook a prospect i ve r and omized trial in 57 patients admitted for suspected amebic liver abscess during a 15-month period . Sixteen patients were excluded from the trial . The remaining 41 patients were r and omly included in one of two study groups to receive amebicidal therapy alone or amebicidal therapy coupled with image-guided percutaneous therapeutic aspiration . All patients in the trial recovered . No statistically significant benefit was demonstrated in the aspiration group for the two objective parameters evaluated : length of hospitalization and duration of time to becoming afebrile . Subjective improvement in symptoms after aspiration was greater in the aspiration group at a marginally statistically significant level . These data do not support the adjunctive performance of percutaneous therapeutic aspiration in the treatment of uncomplicated amebic liver abscess . Amebicidals alone were equally efficacious in treating the group studied Background The aim of the study was to evaluate the clinical presentation , and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses . Methods This is a prospect i ve r and omized comparative study of 60 patients , presented in outpatient and emergency department at the hospital , r and omized equally into two groups , percutaneous needle aspiration and pigtail catheter drainage .  The effectiveness of either treatment was measured in terms of duration of hospital stay , days to achieve clinical improvement , 50 % reduction in abscess cavity size and total/near total resolution of abscess cavity . Independent t-test was used to analyze these parameters . Results The success rate was significantly better in catheter drainage group ( P=0.006 ) . The patients in pigtail catheter drainage group showed earlier clinical improvement ( P=0.039 ) and 50 % decrease in abscess cavity volume ( P=0.000 ) as compared to those who underwent percutaneous needle aspiration . Conclusion Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus Thirty-nine patients with amoebic liver abscess ( ALA ) , admitted to the Central Hospital of Hué ( Vietnam ) , were evaluated in a comparative , prospect i ve and r and omized study for the treatment of ALA . Adult patients with an abscess located in the right liver lobe and an abscess diameter of 6 to 10 cm were included . Bacterial abscesses were excluded by microbiological examination of abscess fluid in all patients . Nineteen patients were treated with metronidazole for 10 days alone and 20 patients were punctured under ultrasound guidance with aspiration of abscess fluid in addition to drug administration . The clinical symptoms fever , pain in right upper abdomen and liver tenderness , and the laboratory parameters erythrocyte sedimentation rate , white blood cells , haemoglobin and C-reactive protein and the abscess size were determined on the day of admission and followed during an observation period of 38 days . Improvement of liver tenderness was significantly faster in the aspiration group during the first 3 days ( P < 0.001 ) , whereas all the other parameters showed no differences between the two groups . This minor benefit is obviously not sufficient to justify routine needle aspiration and advocates drug treatment alone for uncomplicated amoebic liver abscesses with a diameter up to 10 cm located in the right liver lobe Summary Amoebic liver abscess develops in less than 1 % of patients with amoebaisis and metronidazole is the drug of choice for the treatment of amebic liver abscess . Abscesses of less than 5 cm can be treated with metronidazole alone . However , abscesses of more than 10 cm must undergo ultrasound guided percutaneous needle aspiration along with metronidazole . The role of percutaneous needle aspiration in abscesses of 5 to 10 cm is not clear . Fifty-seven patients with a solitary , right lobe , uncomplicated amoebic liverabscess of 5–10 cm were r and omized to receive either metronidazole alone ( control group ; n = 29 ) or ultrasound guided percutaneous needle aspiration along with metronidazole ( intervention group ; n = 28 ) . Although the resolution of pain and fever occurred earlier in the intervention group ( 27 h and 17 h , respectively ) than the control group ( 48 h and 30 h , respectively ) , the difference was not statistically significant ( P = 0.16 and 0.48 , respectively ) . There were no deaths during the study period and treatment failure , complications ( rupture of abscess ) , days to normalization of leukocytosis and duration of hospitalization were similar in both groups . Ultrasound guided percutaneous needle aspiration along with metronidazole was no better than metronidazole alone in the management of uncomplicated , solitary , right lobe amoebic liver abscess of 5 to 10 cm BACKGROUND Amebic liver abscess ( ALA ) is a common and serious problem in our country . There are only a few controlled trials on the efficacy and advantages of combination therapy with percutaneous needle aspiration and pharmacotherapy , over pharmacotherapy alone for amebic liver abscess . MATERIAL AND METHODS This study was conducted to compare the efficacy of two different treatment modalities i.e. drug treatment alone vs. drug treatment and aspiration of abscess cavity in patients with small ( up to 5 cm ) and large ( 5 cm to 10 cm ) size ALA . This is one of the largest single center , prospect i ve , r and omized studies comparing the efficacy of aspiration in ALA . RESULTS ( i ) Mean body temperature , liver tenderness , total leukocyte count ( TLC ) , serum alanine aminotransferase ( ALT ) and liver span were significantly decreased in the aspiration group on days 8 and 15 as compared to non-aspiration group especially in large abscess ( 5 cm to 10 cm ) . ( ii ) Abscess cavity maximum diameter decreased significantly in aspiration group on days 8 and 15 , and 1 month & 3 months in large abscess ( 5 cm to 10 cm ) . CONCLUSIONS ( i ) Needle aspiration along with metronidazole hastens clinical improvement especially in large ( 5 cm up to 10 cm ) cavities in patients with ALA . ( ii ) Aspiration is safe and no major complications occurred . ( iii ) Hence , combination therapy should be the first choice especially in large ALA ( 5 cm to 10 cm ) Evidence shows that the quality of r and omized clinical trials ( RCTs ) affects estimates of intervention efficacy , which is significantly exaggerated in low- quality trials . The present study examines the quality of all 235 RCTs published in HEPATOLOGY from the initiation in 1981 through August 1998 .  Quality was assessed by means of a vali date d 5-point scale and separate quality components associated with empirical evidence of bias . Only 26 % of all RCTs reported sample size calculations , 52 % adequate generation of the allocation sequence , 34 % adequate allocation concealment and 34 % double-blinding . The median quality score of all trials was 3 points ( range , 1 - 5 points ) . Multiple logistic regression analysis explored the association between quality and therapeutic areas , number of centers , external funding , year of publication , and country of origin . High- quality trials were most likely to investigate portal hypertension ( odds ratio [ OR ] : 2.4 ; 95 % CI : 1.1 - 5.5 ; P = .03 ) , be multicentered ( OR : 3.4 ; 95 % CI : 1.3 - 8.9 ; P = .01 ) , sponsored by public organizations ( OR : 4.2 ; 95 % CI : 2.1 - 8.6 ; P = .0001 ) , or the drug and device industry ( OR : 4.7 ; 95 % CI : 2.2 - 10.2 ; P = .0001 ) compared with other therapeutic areas , single-center trials , and trials with no external funding . Quality did not improve with time and was not associated with country of origin . The main conclusions are that the quality of RCTs in HEPATOLOGY needs improvement and that the probability of high quality increased with the number of centers involved and external funding This study aims to compare the therapeutic effectiveness of continuous catheter drainage versus intermittent needle aspiration in the percutaneous treatment of pyogenic liver abscesses . Over a 5-year period , 64 consecutive patients with pyogenic liver abscess were treated with intravenous antibiotics ( ampicillin , cefuroxime , and metronidazole ) and r and omized into two percutaneous treatment groups : continuous catheter drainage ( with an 8F multi-sidehole pigtail catheter ) ; and intermittent needle aspiration ( 18 G disposable trocar needle ) . There was no statistically significant difference between the two groups regarding patient demographics , underlying coexisting disease , abscess size , abscess number , number of loculation of abscess , the presenting clinical symptoms such as fever , abdominal pain , and pretreatment liver function test . Although not statistically significant , the duration of intravenous antibiotics treatment before percutaneous treatment was longer with the catheter group , and the change of antibiotics after the sensitivity test was more frequent with the needle group . The needle group was associated with a higher treatment success rate , a shorter duration of hospital stay , and a lower mortality rate , although this did not reach statistical significance . In conclusion , this study suggests that intermittent needle aspiration is probably as effective as continuous catheter drainage for the treatment of pyogenic liver abscess , although further proof with a large-scale study is necessary . Due to the additional advantages of procedure simplicity , patient comfort , and reduced price , needle aspiration deserves to be considered as a first-line drainage approach Amoebiasis in endemic in the tropical countries with amoebic liver abscesses being a common complication . Different modalities of treatment of amoebic liver abscess are conservative ( medical management ) , percutaneous needle aspiration , percutaneous catheter drainage , surgical drainage and endoscopic drainage . This study was carried out to compare the efficacy , safety and outcome of needle aspiration comparing with percutaneous catheter drainage of large ( > or = 5 cm diameter ) amoebic liver abscesses . This was a prospect i ve study carried over a period of two years ( 2006 - 2008 ) at the general surgery department of Calcutta National Medical College and Hospital , Kolkata . A total of 45 patients were included in this study . All of them had amoebic liver abscess with diameter of abscess cavity > or = 5 cm . They were divided into two groups . Group A included 22 patients and they were treated with needle aspiration . Group B included 23 patients and they were treated by catheter drainage . Improvement in clinical features , liver function tests , ultrasonic evidence of decrease in the size of abscess cavity was considered as criteria for successful treatment . The sex ratio and the age incidence in the two groups were similar . In about 80 % patients the right lobe was affected , in about 18 % the left lobe was affected and in rest the abscess involved both lobes . Needle aspiration was successful in 15 ( 68.2 % ) and catheter drainage was successful in 23 patients ( 100 % ) . The mean hospital stay of patients treated with needle aspiration was more than those treated with catheter drainage . The mean time in days taken for 50 % decrease in the size of abscess cavity was significantly greater in group treated with needle aspiration than in those treated with catheter drainage ( 9 days versus 4 days ) . It is concluded that percutaneous catheter drainage is more effective in management of large amoebic liver abscess than needle aspiration The role of percutaneous needle aspiration for therapy of uncomplicated , large amoebic liver abscess ( ALA ) is not defined . Twenty nine patients of ALA with a cavity larger than 5 cm were r and omised to two groups : ( i ) metronidazole 800 mg tid for 10 days combined with needle aspiration ( group A , n = 15 ) and ( ii ) metronidazole therapy alone ( group B , n = 14 ) . Clinical parameters , viz , fever , pain and abdominal tenderness were recorded daily and grade d 0 to 3 ( in order of increasing severity ) . A statistically significant benefit was demonstrated in group A for clinical parameters evaluated . Group A patients took less time to become afebrile from the grade 2 level as compared to group B ( 3.8 + /- 1.7 days and 5.6 + /- 2.2 days respectively ; p < 0.05 ) . Reduction in pain intensity and abdominal tenderness from grade 2 to 1 also occurred earlier in group A ( 0.7 + /- 0.7 days vs 2.9 + /- 0.9 days for pain , P < 0.001 and 1.7 + /- 0.8 days vs 2.9 + /- 1.2 days for abdominal tenderness , p < 0.001 ) . The mean duration of hospitalization was significantly shorter in group A as compared to group B ( 5.8 + /- 0.8 days vs 7.4 + /- 1.5 days , p < 0.001 ) . Improvement in haematological and biochemical variables was similar in both groups . We conclude that percutaneous therapeutic needle aspiration of uncomplicated , large ALA hastens clinical recovery A prospect i ve study was undertaken to evaluate the clinical and sonographic patterns of resolution in amebic liver abscess ( ALA ) . There were 146 patients of ALA attending the gastroenterology clinic of a tertiary care centre of whom 25 died . Of the remaining 121 patients , 107 were followed up for 20.9 + /- 11.4 months . 14 ( 11.3 % ) patients were lost to follow up before complete disappearance of the cavity . Complete disappearance of the cavity was seen in 84 ( 78.5 % ) and a reduction in volume to 50 % at entry in 23 ( 21.5 % ) . Abdominal pain , fever and hepatomegaly were the predominant forms of clinical presentation . On ultrasound , there were 121 cavities in 107 patients . The most frequent type of lesion was solitary , ( 96 % ) round cavity ( 80.4 % ) in the right lobe of liver ( 85 % ) . Clinical and hematological parameters of resolution occurred rapidly ( 3.2 + /- 2.9 months ) . Sonographic resolution took much longer ( 9.6 + /- 6.8 % months ) in the 84 patients . The remaining 23 patients are on follow up . Three pattern of resolution were observed : Type I -- where complete disappearance of the cavity occurred within 3 months ( 29.8 % ) , Type II -- where a gradual reduction and disappearance of the cavity occurred ( 64.3 % ) and Type III -- where a rapid reduction till 25 % of original cavity size remained and then a delayed resolution occurred ( 5.9 % ) . There were no relapses in the patients on follow up . Factors that influenced healing time included the size of the abscess cavity at admission , hypoalbuminemia and anemia . The type of clinical presentation , nature of therapy , number or location of abscesses and time for clinical resolution did not influence the resolution time . None of the variables studied influenced the pattern of resolution . We conclude that rapid clinical resolution is common in patients with ALA . Sonographic resolution may be delayed and does not warrant additional or prolonged therapy A two-part study was undertaken to determine whether aspiration of amoebic liver abscess ( ALA ) prevents complications .  Eighty patients studied prospect ively were r and omised into aspiration or non-aspiration groups and were treated with metronidazole . Common factors in patients with complicated diseases were determined to formulate and test indications for aspiration . Records of all patients with ALA admitted to King Edward VIII Hospital , Durban , between October 1983 and December 1984 were analysed to test the validity of the criteria derived from the first part of the study . The findings suggest that aspiration influences the course and outcome of ALA and that the criteria are valid although not necessarily complete OBJECTIVE This study was design ed to determine and compare the efficacy of sonographically guided percutaneous needle aspiration and percutaneous catheter drainage in the treatment of liver abscesses . SUBJECTS AND METHODS In a r and omized study , 50 patients ( 38 males and 12 females ; age range , 2 - 72 years ; average age , 35 years ) with liver abscesses ( amebic , 20 ; pyogenic , 11 ; indeterminate , 19 ) underwent either percutaneous needle aspiration ( n = 25 ) or catheter drainage ( n = 25 ) along with appropriate antimicrobial therapy . In patients assigned to the needle aspiration group , an 18-gauge needle was used to aspirate the abscess cavity . Repeated aspiration was attempted only once in each patient not responding to the first aspiration ; nonresponse to the second aspiration was considered failure of treatment , and these patients were given catheter drainage ( however , these patients were not included in the catheter drainage group ) . For catheter drainage , 8- to 12-French catheters were introduced into the abscess cavity using the Seldinger technique . In patients with multiple abscesses ( seven in aspiration group and five in catheter group ) , all the abscesses except those smaller than 3 cm were subjected to percutaneous treatment . Patients were followed up to assess the outcome of the percutaneous treatment , length of hospital stay , and development of any complications .  Sonography was performed every third day during hospitalization . After discharge of the patient , periodic clinical and sonographic examinations were done until total resolution of abscesses was achieved . RESULTS Although percutaneous needle aspiration was successful in only 15 ( 60 % ) of the 25 patients after one ( n = 11 ) or two ( n = 4 ) aspirations , catheter drainage was curative in all 25 patients ( 100 % ) ( p < .05 ) . Among the successfully treated patients , the average time for clinical improvement and the mean hospital stay were similar in the two treatment groups . Although the average time needed for a 50 % reduction in the size of the abscess cavity was significantly ( p < .05 ) greater in the aspiration group than in the catheter group ( 11 days versus 5 days ) , the average time taken for total resolution of abscess was the same ( 15 weeks ) in both groups . No major complications were encountered . No relapse was documented on clinical and sonographic examination during follow-up , which ranged from 8 to 37 weeks . CONCLUSION Our results show that percutaneous catheter drainage is more effective than needle aspiration in the treatment of liver abscesses . Needle aspiration , if limited to two attempts , has a high failure rate Twenty proven cases of amoebic liver abscess were treated at r and om with either tinidazole or metronidazole . The dose of both was 2 g once daily for 2 days . Clinical , radiological , and biochemical follow-up was done for 30 days . Of the 19 patients who completed the trial , complete recovery was observed in all 10 patients given tinidazole and in 5 of 9 patients given metronidazole ( p=0.05 ) . Moreover , patients on tinidazole required repeat aspirations less frequently than those on metronidazole .  Mild gastrointestinal side-effects occurred in 1 patient on metronidazole . The results suggest that tinidazole is a more efficacious drug than metronidazole , with rapid therapeutic effect Summary 20 patients with amoebic liver abscess , confirmed by aspiration of typical amoebic ‘ pus ’ , were treated in r and om order with either tinidazole or metronidazole in a dose of 2 g once daily for 2 days . Clinical , radiological , and biochemical follow-up was done for 1 month . One patient , given metronidazole  , absconded and 19 completed the trial . Complete recovery occurred in all 10 patients given tinidazole but in only 5 of the 9 given metronidazole ( p = 0.05 ) . Patients on tinidazole required repeat aspirations less frequently than those on metronidazole .  Mild gastrointestinal side-effects occurred in 1 patient on metronidazole but in none on tinidazole . From the present study , tinidazole appears to be a more effective , better tolerated drug with a more rapid therapeutic effect than metronidazole Background Metronidazole is a drug of choice for amebic liver abscess ( ALA ) , but has long course and significant side effects . Thus , drugs like tinidazole with a better tolerability record need evaluation . Methods We conducted a r and omized controlled trial at the Department of Gastroenterology , SMS Hospital , Jaipur , India . One hundred and fifty admitted patients were r and omized into two treatment groups , metronidazole ( group M , n = 75 ) and tinidazole ( group T , n = 75 ) . Patients were observed for clinical response , laboratory parameters , imaging , and side effects . Early clinical response ( ECR ) was defined as the absence of fever and abdominal pain within 72 h of treatment . Symptomatic clinical response ( SCR ) was defined as the absence of fever and abdominal pain irrespective of duration of treatment required . Follow up was done at 1 , 3 , and 6 months . Results ECR was 62.3 % in group T vs. 37.7 % in group M ( p = 0.02 ) . SCR was shorter in group T than group M ( 3.29 ± 1.61 days vs. 5.67 ± 2.93 , p ≤ 0.001 ) . Mean residual volume at the end of 1 month was lower in group T ( 130.7 ± 108.1 vs. 184.7 ± 143.3 mL , p = 0.01 ) and no significant difference was seen at 3 and 6 months  . Tinidazole was better tolerated with fewer side effects . Low socioeconomic status , baseline abscess volume > 500 mL , hypoalbuminemia , pleural effusion , and history of ethanol use were associated with a late clinical response on univariate analysis of which low socioeconomic status was the only associated factor . Conclusion Tinidazole , as compared to metronidazole , has early clinical response , shorter treatment course , favorable rate of recovery , and high tolerability ; thus , tinidazole can be preferred over metronidazole in ALA
target: There was no significant difference in relation to the resolution of fever , abscess size , and hospital stay .
  The beneficial effects of PA were seen with medium-to-large ( > 5 cm ) ALA and not with small ( < 5 cm ) ALA .
  Percutaneous aspiration as compared with metronidazole alone results in the early resolution of pain and tenderness in patients with medium-to-large ALA .
  Percutaneous catheter drainage is better for larger ALA .
background: The role of metronidazole alone , percutaneous aspiration ( PA ) , and percutaneous catheter drainage ( PCD ) in the treatment of uncomplicated amebic liver abscess ( ALA ) is still unclear .
  This systematic review and meta- analysis evaluated the available evidence s with regard to treatment modalities in such patients .