Choice “C” is the best answer. It is important to administer a luminal amebicidal agent to eradicate the intestinal carriage after the amebic liver abscess has been treated with tissue amebicides, such as albendazole. Failure to use luminal agents can lead to relapse of infection in approximately 10% of patients. Luminal agents with proven efficacy include diloxanide furoate, iodoquinol, and paromomycin. Diloxanide furoate is free of major adverse effects. The most common adverse effect is flatulence and occasional gastrointestinal upset. Iodoquinol (diiodohydroxyquin) rarely causes abdominal pain, diarrhea, or rash. A structurally related diiodohydroxyquin caused subacute myelopticoneuropathy and is obsolete now. Although paromomycin may occasionally
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Two benzimidazolic drugs, mebendazole and albendazole, are the only anthelmintics effective against cystic echinococcosis. Albendazole and mebendazole are well tolerated but show different efficacy. Albendazole is significantly more effective than mebendazole in the treatment of liver cysts. Benzimidazole treatment alone requires prolonged administration over many weeks, with an unpredictable outcome in terms of response rates in individuals. Treatment with albendazole in Echinococcus granulosus infection can result in an apparent cure in as many as 30% of patients, with a further 40%–50% of patients showing objective evidence of response when observed over the short term. Patients who do not show obvious initial evidence of response may show eradication of the parasite when observed over several years. Duration of therapy and doses are also important. Albendazole efficacy increases with courses of up to 3 months.
Choice “B” is not the best answer. Systemic antifungal agents should be initiated if fungal abscess is suspected and after the abscess has been drained percutaneously or surgically. Initial therapy for fungal abscess is currently amphotericin B. Lipid formulations may offer some benefit, as the drug to lipid moieties allows for concentration in hepatocytes. Further investigation is required for definitive proof. Cases of successful fluconazole treatment after amphotericin failure have been reported; however, its use as an initial agent is not
Two benzimidazolic drugs, mebendazole and albendazole, are the only anthelmintics effective against cystic echinococcosis. Albendazole and mebendazole are well tolerated but show different efficacy. Albendazole is significantly more effective than mebendazole in the treatment of liver cysts. Benzimidazole treatment alone requires prolonged administration over many weeks, with an unpredictable outcome in terms of response rates in individuals. Treatment with albendazole in Echinococcus granulosus infection can result in an apparent cure in as many as 30% of patients, with a further 40%–50% of patients showing objective evidence of response when observed over the short term. Patients who do not show obvious initial evidence of response may show eradication of the parasite when observed over several years. Duration of therapy and doses are also important. Albendazole efficacy increases with courses of up to 3 months.
Choice “B” is not the best answer. Systemic antifungal agents should be initiated if fungal abscess is suspected and after the abscess has been drained percutaneously or surgically. Initial therapy for fungal abscess is currently amphotericin B. Lipid formulations may offer some benefit, as the drug to lipid moieties allows for concentration in hepatocytes. Further investigation is required for definitive proof. Cases of successful fluconazole treatment after amphotericin failure have been reported; however, its use as an initial agent is not