Liver abscess medical therapy

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

• 1. Empiric antimicrobial therapy

• 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.

• 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
• Note: Acute therapy may be followed by 4 weeks of oral antibiotics (fluoroquinolone or cephalosporin)

• 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: