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October 28, 1974

Metronidazole Treatment Of Amebic Abscess

Author Affiliations

USA Fort Huachuca, Ariz

JAMA. 1974;230(4):538. doi:10.1001/jama.1974.03240040016012

To the Editor.—  A dilemma posed by Stillman et al (229:71, 1974) in the treatment of hepatic amebic abscess results from the "failure" of the "drug of choice," metronidazole.I spent two years in Thailand, partly in association with Dr. Wilde, and participated in the treatment of a number of patients with amebic abscess and hepatitis.1 Since we had no such dilemma, it might be of value to point out some of our principles of therapy, which, incidentally, are very similar to those of the Thais, who have a great deal of experience with these diseases.We had noted clinically that metronidazole could not be relied on exclusively for cures. We therefore used emetine, chloroquine, or tetracycline for our primary drugs. We did not routinely aspirate or drain abscesses because medical therapy was entirely adequate and the Thais believe that aspiration is contraindicated. I submit that in this disease