Liver abscess medical therapy: Difference between revisions

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==Medical Therapy==
==Medical Therapy==
*It is essential to differentiate between pyogenic and amebic liver abscesses for appropriate therapy. Differentiation can be established based on serology, culture results, and response to therapy.<ref name="pmid15189463">{{cite journal| author=Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA| title=Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases. | journal=Trop Med Int Health | year= 2004 | volume= 9 | issue= 6 | pages= 718-23 | pmid=15189463 | doi=10.1111/j.1365-3156.2004.01246.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15189463  }} </ref>
*The mainstay of therapy for pyogenic hepatic abscesses is ultrasound/CT guided percutaneous drainage with at least 2 weeks (may last up to 6 weeks) of intravenous antibiotics.<ref name="pmid21435221">{{cite journal| author=Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O et al.| title=Modern management of pyogenic hepatic abscess: a case series and review of the literature. | journal=BMC Res Notes | year= 2011 | volume= 4 | issue=  | pages= 80 | pmid=21435221 | doi=10.1186/1756-0500-4-80 | pmc=PMC3073909 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21435221  }} </ref>
*Empiric antibiotics should only be used initially, with diagnostic aspiration and culture performed as soon as possible.
*Amebic liver abscesses can be treated successfully with antimicrobial agents and do not require drainage except in special conditions, such as:<ref name="pmid12660071">{{cite journal| author=Stanley SL| title=Amoebiasis. | journal=Lancet | year= 2003 | volume= 361 | issue= 9362 | pages= 1025-34 | pmid=12660071 | doi=10.1016/S0140-6736(03)12830-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12660071  }} </ref>
:*Severe clinical illness
:*Uncertain diagnosis
:*No response to metronidazole therapy (after 4 days of treatment)
:*Large left-lobe abscesses (risk of rupture into pericardium)
:*Imminent rupture
===Antibiotic Regimens===
===Antibiotic Regimens===
* '''Pyogenic Liver Abscess'''
* '''Pyogenic Liver Abscess'''
:* '''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>
:* '''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><ref name="pmid21435221">{{cite journal| author=Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O et al.| title=Modern management of pyogenic hepatic abscess: a case series and review of the literature. | journal=BMC Res Notes | year= 2011 | volume= 4 | issue=  | pages= 80 | pmid=21435221 | doi=10.1186/1756-0500-4-80 | pmc=PMC3073909 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21435221 }} </ref>
::* 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)
::* 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)
::* Preferred regimen (2): [[Piperacillin-Tazobactam]] 3.375 g IV q6h
::* Preferred regimen (2): [[Ciprofloxacin]] 400 mg IV q12h {{and}} ([[Metronidazole]] 15 mg/kg IV single dose {{then}} 7.5 mg/kg PO/IV q6h)
::* 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.
::* Preferred regimen (3): [[Piperacillin-Tazobactam]] 3.375 g IV q6h
::* 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 no set duration for treatment, which may vary from 2 to 6 weeks.


:* '''2. Pathogen-directed antimicrobial therapy'''
:* '''2. Pathogen-directed antimicrobial therapy'''

Revision as of 20:55, 8 September 2015

Abscess Main Page

Liver abscess Main Page

Overview

Causes

Classification

Pyogenic liver abscess
Amoebic liver abscess

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]

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.

Medical Therapy

  • It is essential to differentiate between pyogenic and amebic liver abscesses for appropriate therapy. Differentiation can be established based on serology, culture results, and response to therapy.[1]
  • The mainstay of therapy for pyogenic hepatic abscesses is ultrasound/CT guided percutaneous drainage with at least 2 weeks (may last up to 6 weeks) of intravenous antibiotics.[2]
  • Empiric antibiotics should only be used initially, with diagnostic aspiration and culture performed as soon as possible.
  • Amebic liver abscesses can be treated successfully with antimicrobial agents and do not require drainage except in special conditions, such as:[3]
  • Severe clinical illness
  • Uncertain diagnosis
  • No response to metronidazole therapy (after 4 days of treatment)
  • Large left-lobe abscesses (risk of rupture into pericardium)
  • Imminent rupture

Antibiotic Regimens

  • Pyogenic Liver Abscess
  • 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)
  • Preferred regimen (2): Ciprofloxacin 400 mg IV q12h AND (Metronidazole 15 mg/kg IV single dose THEN 7.5 mg/kg PO/IV q6h)
  • Preferred regimen (3): Piperacillin-Tazobactam 3.375 g IV q6h
  • 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 no set duration for treatment, which may vary from 2 to 6 weeks.
  • 2. Pathogen-directed antimicrobial therapy
  • 2.1 Klebsiella spp.
  • 2.2 Escherichia coli
  • Preferred regimen:
  • 2.3 Enterococcus spp.
  • Preferred regimen:
  • 2.4 Anaerobes
  • Preferred regimen:
  • 2.5 Streptococcus viridans
  • Preferred regimen:
  • 2.6 Staphylococcus aureus
  • Preferred regimen:
  • 2.7 Candida spp.
  • Preferred regimen:

References

  1. ↑ Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA (2004). "Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases". Trop Med Int Health. 9 (6): 718–23. doi:10.1111/j.1365-3156.2004.01246.x. PMID 15189463.
  2. ↑ 2.0 2.1 Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O; et al. (2011). "Modern management of pyogenic hepatic abscess: a case series and review of the literature". BMC Res Notes. 4: 80. doi:10.1186/1756-0500-4-80. PMC 3073909. PMID 21435221.
  3. ↑ Stanley SL (2003). "Amoebiasis". Lancet. 361 (9362): 1025–34. doi:10.1016/S0140-6736(03)12830-9. PMID 12660071.
  4. ↑ Rahimian J, Wilson T, Oram V, Holzman RS (2004). "Pyogenic liver abscess: recent trends in etiology and mortality". Clin Infect Dis. 39 (11): 1654–9. doi:10.1086/425616. PMID 15578367.
  5. ↑ Lederman ER, Crum NF (2005). "Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics". Am J Gastroenterol. 100 (2): 322–31. doi:10.1111/j.1572-0241.2005.40310.x. PMID 15667489.
  6. ↑ Lübbert C, Wiegand J, Karlas T (2014). "Therapy of Liver Abscesses". Viszeralmedizin. 30 (5): 334–41. doi:10.1159/000366579. PMC 4513824. PMID 26287275.
  7. ↑ Kurland JE, Brann OS (2004). "Pyogenic and amebic liver abscesses". Curr Gastroenterol Rep. 6 (4): 273–9. PMID 15245694.

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