Pyogenic liver abscess medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Treatment of pyogenic liver abscess include non-surgical treatment and open surgical drainage. Non-surgical treatment includes conservative management with antibiotics alone and percutaneous drainage.^[1]

• Antibiotic therapy is the initial treatment of choice followed by percutaneous drainage. If the abscess does not improve on medical therapy or failure to perform percutaneous drainage, open surgical drainage is performed.
• Treatment of pyogenic liver abscess include:^[1]

Empiric antibiotic therapy based on culture and sensitivity include:^[2][3]

First choice

• 1.Monotherapy

• Preferred regimen(1):Ampicillin–sulbactam 3 g IV every six hours
• Preferred regimen(2):Piperacillin–tazobactam 3.375 or 4.5 g IV every six hours
• Preferred regimen(3):Ticarcillin–clavulanate 3.1 g IV every four hours

• 2.Combination therapy

• Preferred regimen(1):Ceftriaxone 1 g IV every 24 hours or 2 g IV every 12 hours for CNS infection plus Metronidazole 500 mg IV every eight hours

Alternative Emperic Regimens

• 1.Monotherapy

• Preferred regimen(1):Imipenem–cilastatin 500 mg IV every six hours
• Preferred regimen(2):Meropenem 1 g IV every eight hours
• Preferred regimen(3):Doripenem 500 mg IV every eight hours
• Preferred regimen(4):Ertapenem 1 g IV once daily

• 2.Combination therapy

• Fluoroquinolone PLUS metronidazole
• Preferred regimen(1):Ciprofloxacin 400 mg IV every 12 hours or Levofloxacin 500 or 750 mg IV once daily Plus Metronidazole 500 mg IV every eight hours