Comparative study of tinidazole versus metronidazole in treatment of amebic liver abscess: A randomized control trial
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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.
KeywordsAmebic 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.
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 Springer.com. The study protocol was approved by the institutional review board and ethics committee.
- 2.Sharma MP, Ahuja V. Amoebic liver abscess. JIACM. 2003;4:107–11.Google Scholar
- 5.Siddiqui MNA, Ahad MA, Ekram ARMS, Islam QT, Hoque MA, Masum QAAI. Clinico-pathological profile of liver abscess in a teaching hospital. TAJ. 2008;21:44–9.Google Scholar
- 8.Chan RT, Friedman LS. Amebic liver abscess. In: Feldman M, Friedman LS, Brandt LJ, Eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia: Saunders; 2006. p. 1749–53.Google Scholar
- 9.Dias Granado’s CA, Duffus WA, Duffin S, Albrecht H. Parasitic diseases of the liver. In: David Zakim D, Boyer TD, Eds. Hepatology: A Textbook of Liver Disease. 4th ed. Philadelphia: Saunders; 2003. p. 1073–82.Google Scholar
- 11.Sharma MP, Ahuja V. Amoebic liver abscess: clinician’s perspective. Bombay Hosp J. 1997;39:615–9.Google Scholar