Since oral metronidazole is absorbed directly into the portal circulation, theoretically it will concentrate more in liver and hence a question arise about the dosage.
40 mg/kg wt per day Metronidazole for 7-10 days is the best effective dose. Lower dose results in prolonged duration of illness. Metronidazole resistance pattern varies in different countries, it is about 60-80% in India. So low dose therapy is almost out of question in most of the Asian countries.
Aspiration of the abscess followed by IV Metronidazole 400 mg TDS for 7-10 days
Dear Thirunavukarasu,
even as a gastroenterologist and herpetologist I never lost an active thought about the topic you raised. Yet, as it has stringent rationale endorsed by pharmacokinetics, I realised my laziness. Of course I was aware that you can treat any C. diff. colitis with intravenous Metronidazole, as it is mostly excreted by the hepatic/biliary route without metabolism/inactivation. In contrast, for Vancomycin the intravenous route will never work to treat C. diff colitis... However, back to your question, as the Metronidazole takes the 'straight' binary route (with some entero-biliary recirculation), it not only accumulates in the liver but also in the gut. Maybe this is an explanation, why the dosage needed to treat intestinal as well as hepatic amoebiasis does not differ.
All the best, Bruno
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