Indian Journal of Gastroenterology

, Volume 37, Issue 3, pp 196–201 | Cite as

Comparative study of tinidazole versus metronidazole in treatment of amebic liver abscess: A randomized control trial

  • Sudhakar Pandey
  • Gaurav Kumar Gupta
  • Shashank J. Wanjari
  • Sandeep NijhawanEmail author
Original Article



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.


We conducted a randomized controlled trial at the Department of Gastroenterology, SMS Hospital, Jaipur, India. One hundred and fifty admitted patients were randomized 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.


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.


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.


Amebic liver abscess Clinical response Metronidazole Side effects Tinidazole 


Compliance with ethical standards

Conflict of interest

SP, GKG, SJW, and SN declare that they have no conflict of interest.

Ethics statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on The study protocol was approved by the institutional review board and ethics committee.


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Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  • Sudhakar Pandey
    • 1
  • Gaurav Kumar Gupta
    • 1
  • Shashank J. Wanjari
    • 1
  • Sandeep Nijhawan
    • 1
    Email author
  1. 1.Department of GastroenterologySawai Man Singh, Medical CollegeJaipurIndia

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