LIVER ABSCESS, PYOGENIC

LIVER ABSCESS, PYOGENIC

DESCRIPTION

Focal bacterial infection of the liver with pus, usually polymicrobial.

GENERAL MEASURES

Drainage is essential in all cases. This should preferably be done

percutaneously by inserting a catheter under ultrasound guidance.

MEDICINE TREATMENT

Empiric antibiotic therapy

• Benzylpenicillin (penicillin G), IV, 2 million units 6 hourly.

PLUS

• Gentamicin, IV, 6 mg/kg daily.

PLUS

• Metronidazole, oral, 400 mg 8 hourly.

Duration of antibiotic therapy is ill-defined, but may need to be for as long as

12 weeks in cases of multiple abscesses. Continue until drainage is

complete and CRP has returned to normal values. Ultrasound resolution is

very slow and is not useful for monitoring response to therapy.

Reference and further reading

Standard Treatment Guidelines and Essential Medicines List for South Africa 2012 Edition