Liver abscess medical therapy: Difference between revisions
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==Overview== | ==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 can resolve the infection. | |||
===Antibiotic therapy=== | ===Antibiotic therapy=== | ||
Following are the guidelines for the treatment of hepatic abscess*Pending determination of bacterial versus amoebic liver abscess | Following are the guidelines for the treatment of hepatic abscess *Pending determination of bacterial versus amoebic liver abscess | ||
:*Preferred regimen (1): [[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h {{and}} [[Ceftriaxone]] 1-2 gm IV q24h {{or}} [[Piperacillin-Tazobactam]] 3.375 gm IV q4-6h | :*Preferred regimen (1): [[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h {{and}} [[Ceftriaxone]] 1-2 gm IV q24h {{or}} [[Piperacillin-Tazobactam]] 3.375 gm IV q4-6h | ||
:*Preferred regimen (2): [[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h {{and}} [[Ciprofloxacin]] 400 mg IV q12h 750 mg po {{or}} Levofloxacin 750 mg po/IV q24h | :*Preferred regimen (2): [[Metronidazole]] 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h {{and}} [[Ciprofloxacin]] 400 mg IV q12h 750 mg po {{or}} Levofloxacin 750 mg po/IV q24h | ||
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#CT guided percutaneous or drainage through surgery should be performed. | #CT guided percutaneous or drainage through surgery should be performed. | ||
#If anaerobic bacterial infection is suspected, stop metronidazole and start with [[ | #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 [[Yersinia enterocolitica]]. | #If [[hemochromatosis]] is associated with liver abscess then suspect [[Yersinia enterocolitica]]. | ||
Revision as of 12:52, 14 August 2015
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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
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 can resolve the infection.
Antibiotic therapy
Following are the guidelines for the treatment of hepatic abscess *Pending determination of bacterial versus amoebic liver abscess
- Preferred regimen (1): Metronidazole 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h AND Ceftriaxone 1-2 gm IV q24h OR Piperacillin-Tazobactam 3.375 gm IV q4-6h
- Preferred regimen (2): Metronidazole 30-40 mg/kg/day in 3 divided doses IV q8h or 500 mg po q6-8h AND Ciprofloxacin 400 mg IV q12h 750 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 AND Ertapenem 1 gm q24h
- 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.
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)