Amoebic Liver Abscess — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateInfectious DiseasesAmoebic Liver AbscessRACP Adult Medicine

A 40-year-old woman presents with severe right upper quadrant pain and fever. Ultrasound shows multiple liver abscesses. She returned from travel to India 3 months ago. Amoebic serology is strongly positive. What is the first-line treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — IV metronidazole 400 mg TDS for 10 days followed by a luminal agent (paromomycin or diloxanide)

Amoebic liver abscess (Entamoeba histolytica) is treated with IV metronidazole (or tinidazole) as the tissue agent for 5–10 days, followed by a luminal agent (paromomycin 500 mg TDS for 7 days, or diloxanide furoate) to eliminate intraluminal cysts and prevent relapse. The luminal agent step is essential and often overlooked. Percutaneous drainage is reserved for large abscesses (>5 cm) at risk of rupture, failure to respond to medical therapy within 5–7 days, or left lobe abscesses threatening pericardial rupture. Most amoebic abscesses respond to medical therapy alone.

Reference: eTG – 2025 – Antibiotic Guidelines; WHO – 2022 – Amoebiasis Guidelines