Metronidazole and niridazole combined with dehydroemetine in treatment of children with amoebic liver abscess.

Metronidazole and niridazole combined with dehydroemetine in treatment of children with amoebic liver abscess. Metronidazole combined with dehydroemetine cured 13 of 15 children with amoebic liver abscess. An alternative combination of niridazole with dehydroemetine produced cure in 13 of 14 children. No relapses were observed. Electrocardiographic changes were noted in 2 of the first group and in 5 of those who received the second regimen. The results are similar to those obtained with emetine preparations combined with chloroquine. Either metronidazole or niridazole are effective substitutes for chloro-quine and of these preparations metronidazole is preferred. We have shown that emetine hydrochloride or dehydroemetine combined with chloroquine are more effective than any of these drugs when used alone for the treatment of children with amoebic liver abscess (Scragg and Powell, 1966; 1968). Though the results with these combinations showed an improvement on earlier studies (Scragg, 1960), there is still an appreciable mortality and the disease bears a worse prognosis in children than in adults. In recent years clinical trials have shown 2 new amoebicides, niridazole and metronidazole, to be most effective in adults with amoebic liver abscess Elsdon-Dew, 1967). Significant toxic effects have not been demonstrated with metronidazole, but neurological toxicity and ECG changes have limited the use of niridazole as an amoebicide in adults (Powell, Wilmot, and Elsdon-Dew, 1969). However, in African children the latter drug has been extensively used, without adverse effects, for the treatment of urinary tract bilharziasis (Powell et al., 1968), and it may therefore retain a place in the treatment of amoebiasis in paediatric practice. The following trial was designed to assess and compare the efficacy of metronidazole and niri-dazole in combination with dehydroemetine in the treatment of children with amoebic liver abscess. Material and Methods Studies were made on 29 African children, their ages ranging from 4 months to 9 years. The diagnosis of amoebic liver abscess was confirmed by the aspiration of characteristic pus from the liver in all patients; in 20 of the 29 aspirates trophozoites of Entamoeba histolytica were identified. In all patients the amoebic gel-diffusion test was positive. All patients received dehydroemetine, 2 mg.fkg. per day by subcutaneous injection for 10 days, and in addition were randomly placed on either metronidazole, 50 mg./kg. per day, or niridazole, 25 mg.fkg. per day, orally for 10 days. In 25 patients repeated aspirations of the liver were required, and in 4 surgical drainage of the …