Modification and duration of therapy for liver abscess in adults

For adults with liver abscess, modify therapy based on the results of culture and susceptibility testing, if available. Directed therapy is included for:

• Klebsiella pneumoniae liver abscess in adults
• amoebic liver abscess in adults.

If a gentamicin- or tobramycin-containing regimen was used initially and the results of susceptibility testing are not available 72 hours after the initial dose, switch to the ceftriaxone plus metronidazole regimen if intravenous therapy is still required.

The total duration of therapy (intravenous + oral) is usually 4 to 6 weeks. If response to initial drainage is good, switch to directed oral therapy after 2 weeks. If results of culture and susceptibility testing are not available, a reasonable oral option is amoxicillin+clavulanate. If drainage was incomplete or not performed, 4 to 6 weeks of intravenous antibiotic therapy may be required – seek expert advice. Ambulatory antimicrobial therapy may be appropriate for patients requiring longer durations of intravenous therapy.