Pyogenic liver abscess medical therapy

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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 treatment includes conservative management with antibiotics alone and percutaneous drainage.

Treatment

Treatment of pyogenic liver abscess include:

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:

First choice

• 1.Monotherapy

• 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

• 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

Alternative Emperic Regimens

• 1.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

• 2.Monotherapy

• 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