Liver abscess medical therapy: Difference between revisions
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#If anaerobic bacterial infection is suspected, stop metronidazole and start with [[piperacillin tazobactam]] or [[ertapenem]]. ( | #If anaerobic bacterial infection is suspected, stop metronidazole and start with [[piperacillin tazobactam]] or [[ertapenem]]. ( | ||
#[[Bacteroides]] should be treated with empiric metronidazole. | #[[Bacteroides]] should be treated with empiric metronidazole. | ||
#If [[hemochromatosis]] is associated with liver abscess then suspect [[ | #If [[hemochromatosis]] is associated with liver abscess then suspect [[Yersinia enterocolitica]]. | ||
#If pyogenic liver abcess is suspected then the source of infection is either in biliary tract disease or other identifiable GI source. | |||
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==References== | ==References== | ||
Revision as of 03:46, 7 February 2014
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Liver abscess Main Page |
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:
- 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 Yersinia enterocolitica.
- If pyogenic liver abcess is suspected then the source of infection is either in biliary tract disease or other identifiable GI source.
| 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
- ↑ 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) - ↑ 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) - ↑ 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)