Evidence-based therapeutic dilemma in the management of uncomplicated amebic liver abscess: A systematic review and meta-analysis.
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Infective Agents
/ administration & dosage
Combined Modality Therapy
Disease Management
Drainage
/ methods
Female
Humans
Liver Abscess, Amebic
/ therapy
Male
Metronidazole
/ administration & dosage
Middle Aged
Patient Selection
Randomized Controlled Trials as Topic
Suction
Treatment Outcome
Young Adult
Amebic liver abscess
Aspiration
Catheter drainage
Meta-analysis
Journal
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
ISSN: 0975-0711
Titre abrégé: Indian J Gastroenterol
Pays: India
ID NLM: 8409436
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
02
08
2019
accepted:
30
09
2019
pubmed:
23
1
2020
medline:
23
7
2020
entrez:
23
1
2020
Statut:
ppublish
Résumé
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 evidences with regard to treatment modalities in such patients. The database was searched for relevant randomized controlled trials (RCTs) published until May 2019. All studies were assessed for risk of bias. The relevant data were pooled in a random or fixed-effect model to calculate the mean difference (MD) or relative risks. After the detailed screening, 570 patients from 10 RCTs comparing metronidazole alone with metronidazole + PA were included. Most studies had uncertain risk of biases. Days to resolution of abdominal pain (MD - 1.59, 95% confidence interval [CI] - 2.77, - 0.42, I 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. However, discrepancies in RCTs create therapeutic dilemmas necessitating further efforts to generate more reliable data.
Sections du résumé
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 evidences with regard to treatment modalities in such patients.
METHODS
The database was searched for relevant randomized controlled trials (RCTs) published until May 2019. All studies were assessed for risk of bias. The relevant data were pooled in a random or fixed-effect model to calculate the mean difference (MD) or relative risks.
RESULTS
After the detailed screening, 570 patients from 10 RCTs comparing metronidazole alone with metronidazole + PA were included. Most studies had uncertain risk of biases. Days to resolution of abdominal pain (MD - 1.59, 95% confidence interval [CI] - 2.77, - 0.42, I
CONCLUSIONS
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. However, discrepancies in RCTs create therapeutic dilemmas necessitating further efforts to generate more reliable data.
Identifiants
pubmed: 31965537
doi: 10.1007/s12664-019-01004-y
pii: 10.1007/s12664-019-01004-y
doi:
Substances chimiques
Anti-Infective Agents
0
Metronidazole
140QMO216E
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
498-508Références
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