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| ==Overview== | | ==Overview== |
| The mainstay of therapy for pyogenic liver abscesses is [[percutaneous]] drainage and antimicrobial therapy. Empiric therapy for pyogenic [[liver]] [[abscesses]] consists of either a second- or third-generation [[cephalosporin]] with [[metronidazole]] or [[piperacillin-tazobactam]]. [[Amoebiasis|Amebic liver abscesses]] are often treated medically with a short course of [[metronidazole]] or [[tinidazole]] followed by 20 days of [[iodoquinol]].
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| ==Medical Therapy==
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| *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.<ref name="pmid15189463">{{cite journal| author=Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA| title=Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases. | journal=Trop Med Int Health | year= 2004 | volume= 9 | issue= 6 | pages= 718-23 | pmid=15189463 | doi=10.1111/j.1365-3156.2004.01246.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15189463 }} </ref>
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| *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]].<ref name="pmid21435221">{{cite journal| author=Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O et al.| title=Modern management of pyogenic hepatic abscess: a case series and review of the literature. | journal=BMC Res Notes | year= 2011 | volume= 4 | issue= | pages= 80 | pmid=21435221 | doi=10.1186/1756-0500-4-80 | pmc=PMC3073909 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21435221 }} </ref>
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| *[[Empiric]] [[antibiotics]] should only be used initially, with [[diagnostic]] aspiration and culture performed as soon as possible.
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| *Amebic liver abscesses can be treated successfully with antimicrobial agents and do not require drainage except in special conditions, such as:<ref name="pmid12660071">{{cite journal| author=Stanley SL| title=Amoebiasis. | journal=Lancet | year= 2003 | volume= 361 | issue= 9362 | pages= 1025-34 | pmid=12660071 | doi=10.1016/S0140-6736(03)12830-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12660071 }} </ref>
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| :*Severe clinical illness
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| :*Uncertain diagnosis
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| :*No response to [[metronidazole]] therapy (after 4 days of treatment)
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| :*Large left-lobe abscesses (risk of rupture into [[pericardium]])
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| :*Imminent rupture
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| ===Antibiotic Regimens===
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| * '''Pyogenic Liver Abscess'''
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| :* '''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><ref name="pmid21435221">{{cite journal| author=Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O et al.| title=Modern management of pyogenic hepatic abscess: a case series and review of the literature. | journal=BMC Res Notes | year= 2011 | volume= 4 | issue= | pages= 80 | pmid=21435221 | doi=10.1186/1756-0500-4-80 | pmc=PMC3073909 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21435221 }} </ref>
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| ::* 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)
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| ::* Preferred regimen (2): [[Ciprofloxacin]] 400 mg IV q12h {{and}} ([[Metronidazole]] 15 mg/kg IV single dose {{then}} 7.5 mg/kg PO/IV q6h)
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| ::* Preferred regimen (3): [[Piperacillin-Tazobactam]] 3.375 g IV q6h
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| ::* 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.
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| :* '''2. Pathogen-directed antimicrobial therapy'''
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| ::* '''2.1 Klebsiella spp.'''<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>
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| :::* Preferred regimen: [[Gentamicin]] {{and}} ([[Piperacillin-Tazobactam]] 3.375 g IV q6h {{or}} [[Cefazolin]] 0.5-1 g IV q6-8h {{or}} [[Ceftriaxone]] 1-2 g IV/IM q24h {{or}} [[Cefotaxime]] 1-2 g IV or IM q8h) for 2–3 wk
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| :::*Note: Acute therapy may be followed by 4 weeks of oral antibiotics (fluoroquinolone or cephalosporin)
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| * '''Amebic Liver Abscess'''
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| :* Preferred regimen (1): [[Metronidazole]] 2-4 g PO qd for 2 days {{then}} [[Iodoquinol]] 650 mg PO tid for 20 days
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| :* Preferred regimen (2): [[Tinidazole]] 2 g PO qd for 3 days {{then}} [[Iodoquinol]] 650 mg PO tid for 20 days
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| ==References==
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| {{reflist|2}}
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| {{WH}}
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| {{WS}}
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| [[Category:Gastroenterology]]
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| [[Category:Infectious disease]]
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| [[Category:Mature chapter]]
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| [[Category:Disease]]
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