TABLE 1

Analysis of case reports of Refractory or Resistant amoebic liver abscess
Treatment groups Initial regime Author No. of cases Result Of the Treatment Treatment Second regime Dosage Result of the Treatment Remarks
1. Emetime Emmet,J.8 One No Response Chlorpquine 0.5 G/day for 11 days Granulation of ulcer on 7th day. Recovered in few weeks Patient had extensive sloughing and nerotic ulcer at midepigastrium. patient also received antibiotics.
  Sodeman 22 W A, et all One No Response Chlorpquine 0.250 G.B. for 12 daysD. No Response Patient left hospital against medical advice.
  Conan 5 One Partial response Chlorpquine 0.5G./day for 30 days Responded Patient alspo had pleural involvement.
II Emetine with needle aspiration Sharma 19 et al Two cases Patients condition worsened Chlorpquine in two seperate courses at interval of 5 weeks + needle aspiration 1st course of chlorpquine
0.5 G.BD for 4 days, 0.25 G.B.D. for 10 days.
2nd course 0.25 G.OD for 18 days		 Patient recovered after second course patient had hepatomegaly from 3rd I.C.Space upto just above umbilicus in midclavicular line. Total 2400 ml. of pus aspirated in four sessions.
      Patient's general condition worsened Chlorpquine in two seperate courses at an interval of about 10 days + needle aspiration 1st course of chlorpquine 0.5 G.BD for 7 days, 0.25 G.BD for 10 days. 2nd course 0.5 G.OD for 7 days, 0.25 G.OD for 3 weeks Patient recovered after second course Patient also received antibiotics. Total 1470 ml. of pus removed in five sittings and 1305 ml. of bile stained fluid aspirated from liver in two sittings and 128 ozs. of similar fluid removed from the chest and 128 ozs. from the abdomen.
III Emetime with surgical drainage Sodeman 22 et al One Not responded Emetime with chloroquine and surgical drainage Emetime 45 mgms. IM OD for 7 days. Chloroquine 0.5 G.(300 mg. base) BD for 2 days then 0.25 G.(150 mgm. base) BD for 3 weeks Dramatic response Patient also received antibiotics
  Conan 5 One No response Chloroquine 0.75 G./day for 15 days, 0.25G. bi-weekly for 3 months Dramatic response.Wound healing on 12th day The wound was irrigated with 0.012% solution of emetine in saline continuously without response.
  Murgatroyd 15 et al One No response Chloroquine 0.25 G.tds for 18 days. 0.25 G.bi-weekly for 3 months Dramatic response. Wound healing on 12th day. Wound irrigation with 0.012% solution of emetine done. Patient also received antibiotics.
IV Emetine with chloroquine with needle aspiration Sodeman 22 et al One No response Chloroquine dosage increased. Aspiration repeated. 0.250G.BD for 21 days Responded completely -
  Datta 7 et al One out of 20 cases No response - - - Acutely ill patient. Died on 3rd day.
V Chloroquine alone Crane 6 et al Five out of 11 (37.5%) Not inproved - - - Two (18.5%) of the five patients died
VI Chloroquine with needle aspiration Crane 6 et al Ten out of 131 patients (7.6%) No response - - - Two of these ten patients died. (1.5%)
VII Chloroquine with surgical drainage Crane 6 et al 15 out of 33 (28.4%) No response - - - Six of these 15 patients died (11.5%)
VIII Metronidazole alone Henn 12 et al One Patient worsened inspite of the treatment Chloroquine 1 G. stat 0.500 G./day for 20 days + aspiration No response Patient responded to emetine 0.65 G./day for 10 days
  Griffin 9 One No response. The liver scan showed increase in size of the defect Emetine and chloroquine Emetine 65 mg./day for 10 days. Chloroquine 0.250 G.tds. for 3 weeks Dramatic response  
Metronidazole alone Wilde 17 N.M. 2 cases 1st case Worsening under continued treatment Emetine with chloroquine Not mentioned Good response -
  2nd case For amoebic dysentry metronidazole patient developed amoebic liver abscess Not mentioned Good response -    
  Vigg 16 et al 2 out of 50 (4%) One patient did not respond Patient not responding. Metronidazole 0.200 G. tds. for 10 days. Needle aspiration total 5 times. Patient recovered One patient recovered
  Rao 21 et al 3 out of 6 cases (50%) Partial response Emetine 60 mg. OD for 10 days One responded Other two responded to chloroquine in a standard dose.
IX Metronidazole with aspiration Datta 7 et al 7 out of 20 cases (30%) No response Emetine with chloroquine Not mentioned 6 cured One patient was acutely ill. Developed hypotension and died on 3rd day. Autopsy showed multiple abscesses.
X Metronidazole with surgical drainage Stillman 18 et al One No improvement Chloroquine 1 G./day for 2 days.
0.500 G./day for 3 weeks		 Patient responded Patient also received antibiotics. Patient had pleuropulmonary involvement which cleared up.