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]

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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

• If bacterial etiology is suspected then follow these guidelines:.

1. CT guided percutaneous or drainage through surgery should be performed.
2. If anaerobic bacterial infection is suspected, stop metronidazole and start with Piperacillin-Tazobactam or Ertapenem. (
3. Bacteroides should be treated with empiric metronidazole.
4. If hemochromatosis is associated with liver abscess then suspect Yersinia enterocolitica.
5. If pyogenic liver abcess is suspected then the source of infection is either in biliary tract disease or other identifiable GI source.