Liver Abscess (Pyogenic or amoebic)

Treatment of pyogenic liver abscess entails:-

• Source control: usually percutaneous drainage (radiologically guided)
  • Ensure pus for MCS is sent from procedure
• Always consult Micro/ID and hepatology teams
• If there is a relevant travel history, consider amoebiasis. Send serology for amoeba, faeces for OCP and consult Micro/ID (see below).
• Antimicrobials: Start treatment empirically, then tailor treatment according to results from pus culture
  • iv only if NBM or not absorbing. Usual duration approximately 4 weeks. 

For intra-abdominal sepsis see sepsis unknown origin

Preferred

co-trimoxazole 960mg po bd

OR 

co-amoxiclav 625mg po tds 

OR

cefalexin 1g po tds

If drainage of pus is not feasible or delayed, or anaerobic organism isolated from pus: ADD metronidazole 400mg po tds for maximum of 10 days 

co-trimoxazole 960mg iv bd

OR

co-amoxiclav  1.2g iv tds

OR 

ceftriaxone 2g iv od 

If drainage of pus is not feasible or delayed, or anaerobic organism isolated from pus: ADD metronidazole 500mg iv tds for maximum of 10 days

• If there is a relevant travel history (India, Africa, Mexico, and parts of Central and South America), consider amoebiasis.
• Send serology for amoeba, faeces for OCP
• Consult Micro/ID

metronidazole 500mg to 750mg po tds for 7 to 10 days 

Luminal treatment is also advised, discuss with micro/ID.

Discuss with Micro/ID