Liver abscess medical therapy: Difference between revisions
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===Antibiotic therapy=== | ===Antibiotic therapy=== | ||
Following are the guidelines for the treatment of hepatic abscess | Following are the guidelines for the treatment of hepatic abscess*Pending determination of bacterial versus amoebic liver abscess | ||
:*Preferred regimen (1): [[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h {{and}} [[Ceftriaxone]] 1-2 gm IV q24h {{or}} [[Piperacillin-Tazobactam]] 3.375 gm IV q4-6h | :*Preferred regimen (1): [[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h {{and}} [[Ceftriaxone]] 1-2 gm IV q24h {{or}} [[Piperacillin-Tazobactam]] 3.375 gm IV q4-6h | ||
:*Preferred regimen (2): [[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h {{and}} [[Ciprofloxacin]] 400 mg IV q12h 750 mg po {{or}} Levofloxacin 750 mg po/IV q24h | :*Preferred regimen (2): [[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h {{and}} [[Ciprofloxacin]] 400 mg IV q12h 750 mg po {{or}} Levofloxacin 750 mg po/IV q24h | ||
:*Alternate Regimen: [[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h {{and}} [[Ertapenem]] 1 gm q24h | :*Alternate Regimen: [[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h {{and}} [[Ertapenem]] 1 gm q24h | ||
*If bacterial etiology is suspected then follow these guidelines: | *If bacterial etiology is suspected then follow these guidelines:.<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> | ||
#CT guided percutaneous or drainage through surgery should be performed. | #CT guided percutaneous or drainage through surgery should be performed. | ||
#If anaerobic bacterial infection is suspected, stop metronidazole and start with [[piperacillin tazobactam]] or [[ertapenem]]. ( | #If anaerobic bacterial infection is suspected, stop metronidazole and start with [[piperacillin tazobactam]] or [[ertapenem]]. ( | ||
Revision as of 14:47, 12 August 2015
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Liver abscess Main Page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]
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Overview
Treatment usually consists of placing a tube through the skin to drain the abscess. Less often, surgery is required. Antibiotics are used for about 4 - 6 weeks. Sometimes, antibiotics alone can cure the infection.
Antibiotic therapy
Following are the guidelines for the treatment of hepatic abscess*Pending determination of bacterial versus amoebic liver abscess
- Preferred regimen (1): Metronidazole 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h AND Ceftriaxone 1-2 gm IV q24h OR Piperacillin-Tazobactam 3.375 gm IV q4-6h
- Preferred regimen (2): Metronidazole 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h AND Ciprofloxacin 400 mg IV q12h 750 mg po OR Levofloxacin 750 mg po/IV q24h
- Alternate Regimen: Metronidazole 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h AND Ertapenem 1 gm q24h
- CT guided percutaneous or drainage through surgery should be performed.
- If anaerobic bacterial infection is suspected, stop metronidazole and start with piperacillin tazobactam or ertapenem. (
- Bacteroides should be treated with empiric metronidazole.
- If hemochromatosis is associated with liver abscess then suspect Yersinia enterocolitica.
- If pyogenic liver abcess is suspected then the source of infection is either in biliary tract disease or other identifiable GI source.
References
- ↑ Lee, SS.; Chen, YS.; Tsai, HC.; Wann, SR.; Lin, HH.; Huang, CK.; Liu, YC. (2008). "Predictors of septic metastatic infection and mortality among patients with Klebsiella pneumoniae liver abscess". Clin Infect Dis. 47 (5): 642–50. doi:10.1086/590932. PMID 18643760. Unknown parameter
|month=ignored (help) - ↑ Fang, CT.; Lai, SY.; Yi, WC.; Hsueh, PR.; Liu, KL.; Chang, SC. (2007). "Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess". Clin Infect Dis. 45 (3): 284–93. doi:10.1086/519262. PMID 17599305. Unknown parameter
|month=ignored (help) - ↑ Siu, LK.; Yeh, KM.; Lin, JC.; Fung, CP.; Chang, FY. (2012). "Klebsiella pneumoniae liver abscess: a new invasive syndrome". Lancet Infect Dis. 12 (11): 881–7. doi:10.1016/S1473-3099(12)70205-0. PMID 23099082. Unknown parameter
|month=ignored (help)