Decision making policies on the utilization of antimalarials in response to a modification of chloroquine efficacity. Applications to Africa

: Amoebic liver abscess is a common disease in developing countries. Although therapy is now perfectly standardized, errors and inaccuracies are frequent in daily practice. A study was performed at the Calmette Hospital in Phnom Penh (Cambodia) to evaluate and improve this situation. Diagnostic criteria and the outcome of treatment with oral or parenteral metronidazole were analyzed in 38 patients presenting amoebic liver abscess. Hepatalgia was observed in 100% of cases. Hyperleukocytosis and enhancement of the sedimentation rate occurred in 95% of cases. Diagnosis was confirmed by ultrasonography. Serodiagnosis, given its high cost, was not indispensable. Metronidazole was of comparable effectiveness and tolerance (90%) whether administered by the oral or parenteral route. The parenteral route should be used only for patents presenting digestive intolerance. Drainage of the abscess is necessary in cases characterized by immediate complications, abscesses with diameters greater than 120 mm and absence of improvement after 5 days of treatment.