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| __NOTOC__ | | __NOTOC__ |
| {{Liver abscess}} | | {{Liver abscess}} |
| {{CMG}}; {{AE}} {{chetan}} | | {{CMG}}; {{AE}} {{SSK}} |
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| ==Overview== | | ==Overview== |
| The mainstay of therapy for a hepatic abscess is percutaneous drainage and antimicrobial therapy. Antimicrobial therapy is administered for about 4-6 weeks. Occasionally, antimicrobial therapy alone may resolve the infection.
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| ==Medical Therapy==
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| ===Antibiotic Regimens===
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| * '''Pyogenic Liver Abscess'''
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| :* '''1. Empiric antimicrobial therapy'''<ref name="pmid15578367">{{cite journal| author=Rahimian J, Wilson T, Oram V, Holzman RS| title=Pyogenic liver abscess: recent trends in etiology and mortality. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 11 | pages= 1654-9 | pmid=15578367 | doi=10.1086/425616 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15578367 }} </ref><ref name="pmid15667489">{{cite journal| author=Lederman ER, Crum NF| title=Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. | journal=Am J Gastroenterol | year= 2005 | volume= 100 | issue= 2 | pages= 322-31 | pmid=15667489 | doi=10.1111/j.1572-0241.2005.40310.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15667489 }} </ref><ref name="pmid26287275">{{cite journal| author=Lübbert C, Wiegand J, Karlas T| title=Therapy of Liver Abscesses. | journal=Viszeralmedizin | year= 2014 | volume= 30 | issue= 5 | pages= 334-41 | pmid=26287275 | doi=10.1159/000366579 | pmc=PMC4513824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26287275 }} </ref><ref name="pmid15245694">{{cite journal| author=Kurland JE, Brann OS| title=Pyogenic and amebic liver abscesses. | journal=Curr Gastroenterol Rep | year= 2004 | volume= 6 | issue= 4 | pages= 273-9 | pmid=15245694 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15245694 }} </ref>
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| ::* Preferred regimen (1): ([[Ceftriaxone]] 1-2 g IV/IM q24h {{or}} [[Cefotaxime]] 1-2 g IV or IM q8h) {{and}} ([[Metronidazole]] 15 mg/kg IV single dose {{then}} 7.5 mg/kg PO/IV q6h)
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| ::* Preferred regimen (2): [[Piperacillin-Tazobactam]] 3.375 g IV q6h
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| ::* Note: The empiric therapy for pyogenic abscesses should be based on local resistance patterns, with particular attention to resistant Klebsiella spp. Ampicillin is not recommended due to the high resistance found among Klebsiella spp. There is not set duration for treatment, which may vary from 2 to 6 weeks.
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| :* '''2. Pathogen-directed antimicrobial therapy'''
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| ::* '''2.1 Klebsiella spp.'''
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| :::* Preferred regimen: [[Gentamicin]] {{and}} ([[Piperacillin-Tazobactam]] 3.375 g IV q6h {{or}} [[Cefazolin]] {{or}} [[Ceftriaxone]] 1-2 g IV/IM q24h {{or}} [[Cefotaxime]] 1-2 g IV or IM q8h) for 2–3 wk
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| :::*Note: Acute therapy may be followed by 4 weeks of oral antibiotics (fluoroquinolone or cephalosporin)
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| ::* '''2.2 Escherichia coli'''
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| :::* Preferred regimen:
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| ::* '''2.3 Enterococcus spp.'''
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| :::* Preferred regimen:
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| ::* '''2.4 Anaerobes'''
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| :::* Preferred regimen:
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| ::* '''2.5 Streptococcus viridans'''
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| :::* Preferred regimen:
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| ::* '''2.6 Staphylococcus aureus'''
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| :::* Preferred regimen:
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| ::* '''2.7 Candida spp.'''
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| :::* Preferred regimen:
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| ==References==
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| {{reflist|2}}
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| {{WH}}
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| {{WS}}
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| [[Category:Gastroenterology]]
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| [[Category:Infectious disease]]
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| [[Category:Mature chapter]]
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| [[Category:Disease]]
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