Liver Abscess

Refers to single or multiple abscesses on abdominal US or CT; ~half are due to identifiable GI source

Surgical/radiology consultation for drainage. Send specimen for cultures and histopathology

Obtain blood cultures

Testing for amebiasis is recommended if no known predisposition to pyogenic liver abscess (e.g. biliary disease), particularly in those from/with recent travel to endemic areas (e.g. Africa, India)

Serology for Entamoeba histolytica can take up to 2 weeks; consult microbiology for molecular testing on stool/abscess fluid

Duration of Therapy

Treatment duration is guided by response to therapy

Empiric Therapy

AND

Use higher Metronidazole doses until amebiasis ruled out; do not use Pip/Tazo monotherapy empirically

Tailor antimicrobials to culture and sensitivities; long-term polymicrobial coverage is debatable

Potent oral therapies can be used; there is no need for prolonged IV treatment

Oral Step-Down

  • Ciprofloxacin 500mg PO BID

  • Moxifloxacin 400mg PO Q24H

  • Amoxicillin 500mg PO TID

  • all

with or without Metronidazole 500mg PO BID

  • Metronidazole 500mg PO TID for amebiasis