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

• It is essential to differentiate between pyogenic and amebic liver abscesses for appropriate therapy. Differentiation can be established based on serology, culture results, and response to therapy.
• The mainstay of therapy for pyogenic hepatic abscesses is ultrasound/CT guided percutaneous drainage with at least 2 weeks (may last up to 6 weeks) of intravenous antibiotics.
• Empiric antibiotics should only be used initially, with diagnostic aspiration and culture performed as soon as possible.
• Amebic liver abscesses can be treated successfully with antimicrobial agents and do not require drainage except in special conditions, such as:

• Severe clinical illness
• Uncertain diagnosis
• No response to metronidazole therapy (after 4 days of treatment)
• Large left-lobe abscesses (risk of rupture into pericardium)
• Imminent rupture

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): Ciprofloxacin 400 mg IV q12h AND (Metronidazole 15 mg/kg IV single dose THEN 7.5 mg/kg PO/IV q6h)
• Preferred regimen (3): 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 no 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: