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==Medical Therapy==
==Medical Therapy==
===Antibiotic therapy===
===Antibiotic Regimens===
Following are the guidelines for the treatment of hepatic abscess *Pending determination of bacterial versus amoebic liver abscess
* '''Pyogenic 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
:* '''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>
:*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 (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)
:*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
::* Preferred regimen (2): [[Piperacillin-Tazobactam]] 3.375 g IV q6h
*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>
::* 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.


#CT guided percutaneous or drainage through surgery  should be performed.
:* '''2. Pathogen-directed antimicrobial therapy'''
#If anaerobic bacterial infection is suspected, stop metronidazole and start with [[Piperacillin-Tazobactam]] or [[Ertapenem]]. (
::* '''2.1 Klebsiella spp.'''
#[[Bacteroides]] should be treated with empiric metronidazole.
:::* 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 
#If [[hemochromatosis]] is associated with liver abscess then suspect [[Yersinia enterocolitica]]. 
:::*Note: Acute therapy may be followed by 4 weeks of oral antibiotics (fluoroquinolone or cephalosporin)
#If pyogenic liver abcess is suspected then the source of infection is either in biliary tract disease or other identifiable GI source.
::* '''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==
==References==

Revision as of 20:30, 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

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): 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 not 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. ↑ 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.
  2. ↑ 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.
  3. ↑ Lübbert C, Wiegand J, Karlas T (2014). "Therapy of Liver Abscesses". Viszeralmedizin. 30 (5): 334–41. doi:10.1159/000366579. PMC 4513824. PMID 26287275.
  4. ↑ Kurland JE, Brann OS (2004). "Pyogenic and amebic liver abscesses". Curr Gastroenterol Rep. 6 (4): 273–9. PMID 15245694.

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