Liver abscess medical therapy: Difference between revisions

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__NOTOC__
__NOTOC__
{{Liver abscess}}
{{Liver abscess}}
{{CMG}}
{{CMG}}; {{AE}} {{chetan}}


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==Overview==
==Overview==
Treatment usually consists of placing a tube through the skin to drain the abscess. Less often, surgery is required. [[Antibiotic]]s are used for about 4 - 6 weeks. Sometimes, antibiotics alone can cure the infection.  Commonly used antibiotics include [[penicillin]]s, [[aminoglycoside]]s, [[metronidazole]] and  [[cephalosporin]]s.
Treatment usually consists of placing a tube through the skin to drain the abscess. Less often, surgery is required. [[Antibiotic]]s are used for about 4 - 6 weeks. Sometimes, antibiotics alone can cure the infection.  Commonly used antibiotics include [[penicillin]]s, [[aminoglycoside]]s, [[metronidazole]] and  [[cephalosporin]]s.
===Antibiotic therapy===
Following are the guidelines for the treatment of hepatic abscess.<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>
*If [[amoeba]] is suspected treat with  empiric [[metronidazole]] only .
*If bacterial etiology is suspected then follow these guidelines:
#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 [[Y.enterocolitica]]. 
 
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Hepatic Abscess }}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Pending determination of bacterial versus amoebic liver abscess'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ceftriaxone]] 1-2 gm IV q24h'''''<br> OR <br>▸'''''[[ Piperacillin-Tazobactam]]  3.375 gm IV q4-6h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | OR
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Ciprofloxacin]] 400 mg IV q12h 750 mg mg po''''' <br>OR<br >▸'''''[[Levofloxacin]] 750 mg po/IV q24h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternate Regimen''''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Ertapenem]] 1 gm q24h '''''
|}
|}


==References==
==References==

Revision as of 03:43, 7 February 2014

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]

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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. Commonly used antibiotics include penicillins, aminoglycosides, metronidazole and cephalosporins.

Antibiotic therapy

Following are the guidelines for the treatment of hepatic abscess.[1][2][3]

  • If amoeba is suspected treat with empiric metronidazole only .
  • If bacterial etiology is suspected then follow these guidelines:
  1. CT guided percutaneous or drainage through surgery should be performed.
  2. If anaerobic bacterial infection is suspected, stop metronidazole and start with piperacillin tazobactam or ertapenem. (
  3. Bacteroides should be treated with empiric metronidazole.
  4. If hemochromatosis is associated with liver abscess then suspect Y.enterocolitica.


Hepatic Abscess
Preferred Regimen
Pending determination of bacterial versus amoebic liver abscess
▸ Metronidazole 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h
PLUS
▸ Ceftriaxone 1-2 gm IV q24h
OR
▸Piperacillin-Tazobactam 3.375 gm IV q4-6h
OR
▸Metronidazole 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h
PLUS
▸Ciprofloxacin 400 mg IV q12h 750 mg 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
PLUS
▸Ertapenem 1 gm q24h

|}




References

  1. ↑ 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)
  2. ↑ 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)
  3. ↑ 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)

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