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| __NOTOC__ | | __NOTOC__ |
| {{Liver abscess}} | | {{Liver abscess}} |
| {{CMG}}; {{AE}} {{chetan}} | | {{CMG}}; {{AE}} {{SSK}} |
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| Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.
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| ==Overview== | | ==Overview== |
| Treatment usually consists of placing a tube through the skin to drain the abscess. Less often, surgery is required. [[Antibiotic]]s are used for about 4 - 6 weeks. Sometimes, antibiotics alone can cure the infection. Commonly used antibiotics include [[penicillin]]s, [[aminoglycoside]]s, [[metronidazole]] and [[cephalosporin]]s.
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| ===Antibiotic therapy===
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| Following are the guidelines for the treatment of hepatic abscess.<ref name="Lee-2008">{{Cite journal | last1 = Lee | first1 = SS. | last2 = Chen | first2 = YS. | last3 = Tsai | first3 = HC. | last4 = Wann | first4 = SR. | last5 = Lin | first5 = HH. | last6 = Huang | first6 = CK. | last7 = Liu | first7 = YC. | title = Predictors of septic metastatic infection and mortality among patients with Klebsiella pneumoniae liver abscess. | journal = Clin Infect Dis | volume = 47 | issue = 5 | pages = 642-50 | month = Sep | year = 2008 | doi = 10.1086/590932 | PMID = 18643760 }}</ref><ref name="Fang-2007">{{Cite journal | last1 = Fang | first1 = CT. | last2 = Lai | first2 = SY. | last3 = Yi | first3 = WC. | last4 = Hsueh | first4 = PR. | last5 = Liu | first5 = KL. | last6 = Chang | first6 = SC. | title = Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. | journal = Clin Infect Dis | volume = 45 | issue = 3 | pages = 284-93 | month = Aug | year = 2007 | doi = 10.1086/519262 | PMID = 17599305 }}</ref><ref name="Siu-2012">{{Cite journal | last1 = Siu | first1 = LK. | last2 = Yeh | first2 = KM. | last3 = Lin | first3 = JC. | last4 = Fung | first4 = CP. | last5 = Chang | first5 = FY. | title = Klebsiella pneumoniae liver abscess: a new invasive syndrome. | journal = Lancet Infect Dis | volume = 12 | issue = 11 | pages = 881-7 | month = Nov | year = 2012 | doi = 10.1016/S1473-3099(12)70205-0 | PMID = 23099082 }}</ref>
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| *If [[amoeba]] is suspected treat with empiric [[metronidazole]] only .
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| *If bacterial etiology is suspected then follow these guidelines:
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| #CT guided percutaneous or drainage through surgery should be performed.
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| #If anaerobic bacterial infection is suspected, stop metronidazole and start with [[piperacillin tazobactam]] or [[ertapenem]]. (
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| #[[Bacteroides]] should be treated with empiric metronidazole.
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| #If [[hemochromatosis]] is associated with liver abscess then suspect [[Y.enterocolitica]].
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Hepatic Abscess }}
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Pending determination of bacterial versus amoebic liver abscess'''''
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h'''''
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ceftriaxone]] 1-2 gm IV q24h'''''<br> OR <br>▸'''''[[ Piperacillin-Tazobactam]] 3.375 gm IV q4-6h'''''
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | OR
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h'''''
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Ciprofloxacin]] 400 mg IV q12h 750 mg mg po''''' <br>OR<br >▸'''''[[Levofloxacin]] 750 mg po/IV q24h'''''
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternate Regimen''''''
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h'''''
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Ertapenem]] 1 gm q24h '''''
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| |}
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| |}
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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:Needs content]]
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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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