Pyogenic liver abscess medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Treatment of pyogenic liver abscess include non-surgical treatment and open surgical drainage. Non-surgical | Treatment of pyogenic liver abscess include non-surgical treatment and open surgical drainage. Non-surgical treatment includes conservative management with [[antibiotics]] alone and [[percutaneous]] drainage.<ref name="pmid21206721">{{cite journal| author=Malik AA, Bari SU, Rouf KA, Wani KA| title=Pyogenic liver abscess: Changing patterns in approach. | journal=World J Gastrointest Surg | year= 2010 | volume= 2 | issue= 12 | pages= 395-401 | pmid=21206721 | doi=10.4240/wjgs.v2.i12.395 | pmc=3014521 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21206721 }} </ref> | ||
==Treatment== | ==Treatment== | ||
*Antibiotic therapy is the initial treatment of choice followed by percutaneous drainage. If the abscess does not improve on medical therapy or failure to perform percutaneous drainage, open surgical drainage is performed. | *[[Antibiotic therapy]] is the initial treatment of choice followed by [[percutaneous]] drainage. If the abscess does not improve on medical therapy or failure to perform percutaneous drainage, open surgical drainage is performed. | ||
*Treatment of pyogenic liver abscess include:<ref name="pmid21206721">{{cite journal| author=Malik AA, Bari SU, Rouf KA, Wani KA| title=Pyogenic liver abscess: Changing patterns in approach. | journal=World J Gastrointest Surg | year= 2010 | volume= 2 | issue= 12 | pages= 395-401 | pmid=21206721 | doi=10.4240/wjgs.v2.i12.395 | pmc=3014521 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21206721 }} </ref> | *Treatment of pyogenic liver abscess include:<ref name="pmid21206721">{{cite journal| author=Malik AA, Bari SU, Rouf KA, Wani KA| title=Pyogenic liver abscess: Changing patterns in approach. | journal=World J Gastrointest Surg | year= 2010 | volume= 2 | issue= 12 | pages= 395-401 | pmid=21206721 | doi=10.4240/wjgs.v2.i12.395 | pmc=3014521 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21206721 }} </ref> | ||
{{Family tree/start}} | {{Family tree/start}} | ||
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{{Family tree | | | B01 | | | | B02|B01=Non-surgical treatment|B02= Open surgical drainage}} | {{Family tree | | | B01 | | | | B02|B01=Non-surgical treatment|B02= Open surgical drainage}} | ||
{{family tree | |,|-|^|-|.|}} | {{family tree | |,|-|^|-|.|}} | ||
{{family tree | C01 | | C02|C01=Conservative management with antibiotics alone|C02=Percutaneous drainage}} | {{family tree | C01 | | C02|C01=Conservative management with [[antibiotics]] alone|C02=[[Percutaneous]] drainage}} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
==Medical Therapy== | ==Medical Therapy== | ||
Empiric [[antibiotic]] therapy based on culture and sensitivity include:<ref name="pmid12380791">{{cite journal| author=Chen YW, Chen YS, Lee SS, Yen MY, Wann SR, Lin HH et al.| title=A pilot study of oral fleroxacin once daily compared with conventional therapy in patients with pyogenic liver abscess. | journal=J Microbiol Immunol Infect | year= 2002 | volume= 35 | issue= 3 | pages= 179-83 | pmid=12380791 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12380791 }} </ref><ref name="pmid15057896">{{cite journal| author=Yu SC, Ho SS, Lau WY, Yeung DT, Yuen EH, Lee PS et al.| title=Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. | journal=Hepatology | year= 2004 | volume= 39 | issue= 4 | pages= 932-8 | pmid=15057896 | doi=10.1002/hep.20133 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15057896 }} </ref> | Empiric [[antibiotic]] therapy based on [[Culture medium|culture]] and sensitivity include:<ref name="pmid12380791">{{cite journal| author=Chen YW, Chen YS, Lee SS, Yen MY, Wann SR, Lin HH et al.| title=A pilot study of oral fleroxacin once daily compared with conventional therapy in patients with pyogenic liver abscess. | journal=J Microbiol Immunol Infect | year= 2002 | volume= 35 | issue= 3 | pages= 179-83 | pmid=12380791 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12380791 }} </ref><ref name="pmid15057896">{{cite journal| author=Yu SC, Ho SS, Lau WY, Yeung DT, Yuen EH, Lee PS et al.| title=Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. | journal=Hepatology | year= 2004 | volume= 39 | issue= 4 | pages= 932-8 | pmid=15057896 | doi=10.1002/hep.20133 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15057896 }} </ref> | ||
'''First choice''' | '''First choice''' | ||
*1.Monotherapy | *1.[[Monotherapy]] | ||
:*Preferred regimen(1):[[Ampicillin]]-[[sulbactam]] 3 g IV every six hours | :*Preferred regimen(1):[[Ampicillin]]-[[sulbactam]] 3 g IV every six hours | ||
:*Preferred regimen(2):[[Piperacillin]]-[[tazobactam]] 3.375 or 4.5 g IV every six hours | :*Preferred regimen(2):[[Piperacillin]]-[[tazobactam]] 3.375 or 4.5 g IV every six hours | ||
:*Preferred regimen(3):[[Ticarcillin]]-[[clavulanate]] 3.1 g IV every four hours | :*Preferred regimen(3):[[Ticarcillin]]-[[clavulanate]] 3.1 g IV every four hours | ||
*2.Combination therapy | *2.[[Combination therapy]] | ||
:*Preferred regimen(1):[[Ceftriaxone]] 1 g IV every 24 hours or 2 g IV every 12 hours for [[CNS]] [[infection]] '''plus''' [[Metronidazole]] 500 mg IV every eight hours | :*Preferred regimen(1):[[Ceftriaxone]] 1 g IV every 24 hours or 2 g IV every 12 hours for [[CNS]] [[infection]] '''plus''' [[Metronidazole]] 500 mg IV every eight hours | ||
'''Alternative Emperic Regimens''' | '''Alternative Emperic Regimens''' | ||
*1. | *1.[[Monotherapy]] | ||
:*Preferred regimen(1):[[Imipenem]]-[[cilastatin]] 500 mg IV every six hours | :*Preferred regimen(1):[[Imipenem]]-[[cilastatin]] 500 mg IV every six hours | ||
:*Preferred regimen(2):[[Meropenem]] 1 g IV every eight hours | :*Preferred regimen(2):[[Meropenem]] 1 g IV every eight hours | ||
:*Preferred regimen(3):[[Doripenem]] 500 mg IV every eight hours | :*Preferred regimen(3):[[Doripenem]] 500 mg IV every eight hours | ||
:*Preferred regimen(4):[[Ertapenem]] 1 g IV once daily | :*Preferred regimen(4):[[Ertapenem]] 1 g IV once daily | ||
*2.[[Combination therapy]] | |||
:*[[Fluoroquinolone]] PLUS [[metronidazole]] | |||
:*Preferred regimen(1):[[Ciprofloxacin]] 400 mg IV every 12 hours '''or''' [[Levofloxacin]] 500 or 750 mg IV once daily '''Plus''' [[Metronidazole]] 500 mg IV every eight hours | |||
: | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Hepatology]] | |||
Latest revision as of 23:55, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]
Overview
Treatment of pyogenic liver abscess include non-surgical treatment and open surgical drainage. Non-surgical treatment includes conservative management with antibiotics alone and percutaneous drainage.[1]
Treatment
- Antibiotic therapy is the initial treatment of choice followed by percutaneous drainage. If the abscess does not improve on medical therapy or failure to perform percutaneous drainage, open surgical drainage is performed.
- Treatment of pyogenic liver abscess include:[1]
| Treatment | |||||||||||||||||||||
| Non-surgical treatment | Open surgical drainage | ||||||||||||||||||||
| Conservative management with antibiotics alone | Percutaneous drainage | ||||||||||||||||||||
Medical Therapy
Empiric antibiotic therapy based on culture and sensitivity include:[2][3]
First choice
- Preferred regimen(1):Ampicillin-sulbactam 3 g IV every six hours
- Preferred regimen(2):Piperacillin-tazobactam 3.375 or 4.5 g IV every six hours
- Preferred regimen(3):Ticarcillin-clavulanate 3.1 g IV every four hours
- Preferred regimen(1):Ceftriaxone 1 g IV every 24 hours or 2 g IV every 12 hours for CNS infection plus Metronidazole 500 mg IV every eight hours
Alternative Emperic Regimens
- Preferred regimen(1):Imipenem-cilastatin 500 mg IV every six hours
- Preferred regimen(2):Meropenem 1 g IV every eight hours
- Preferred regimen(3):Doripenem 500 mg IV every eight hours
- Preferred regimen(4):Ertapenem 1 g IV once daily
- Fluoroquinolone PLUS metronidazole
- Preferred regimen(1):Ciprofloxacin 400 mg IV every 12 hours or Levofloxacin 500 or 750 mg IV once daily Plus Metronidazole 500 mg IV every eight hours
References
- ↑ 1.0 1.1 Malik AA, Bari SU, Rouf KA, Wani KA (2010). "Pyogenic liver abscess: Changing patterns in approach". World J Gastrointest Surg. 2 (12): 395–401. doi:10.4240/wjgs.v2.i12.395. PMC 3014521. PMID 21206721.
- ↑ Chen YW, Chen YS, Lee SS, Yen MY, Wann SR, Lin HH; et al. (2002). "A pilot study of oral fleroxacin once daily compared with conventional therapy in patients with pyogenic liver abscess". J Microbiol Immunol Infect. 35 (3): 179–83. PMID 12380791.
- ↑ Yu SC, Ho SS, Lau WY, Yeung DT, Yuen EH, Lee PS; et al. (2004). "Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration". Hepatology. 39 (4): 932–8. doi:10.1002/hep.20133. PMID 15057896.