Version June 2024
| Regimen | Dose (adult)* |
| Preferred¶ | |
| Beta-lactam/beta-lactamase inhibitor:Δ | |
| Piperacillin-tazobactam | 3.375 or 4.5 g IV every six hours◊ |
| Ticarcillin-clavulanate§ | 3.1 g IV every four hours |
| Third generation cephalosporin¥ PLUS metronidazole: | |
| Ceftriaxone plus | 2 g IV once daily |
| Metronidazole | 500 mg IV or orally every eight hours |
| Ampicillin PLUS gentamicin PLUS metronidazole: | |
| Ampicillin plus | 2 g IV every four to six hours |
| Gentamicin plus | 5 to 7 mg per kg IV daily‡ |
| Metronidazole | 500 mg IV or orally every eight hours |
| Alternative regimens¶ | |
| Fluoroquinolone PLUS metronidazole: | |
| Ciprofloxacin or | 400 mg IV every 12 hours or 750 mg orally twice daily |
| Levofloxacin plus | 500 or 750 mg IV or orally once daily |
| Metronidazole | 500 mg IV or orally every eight hours |
| Carbapenem:¶† | |
| Imipenem-cilastatin | 500 mg IV every six hours |
| Meropenem | 1 g IV every eight hours |
| Ertapenem | 1 g IV once daily |
IV: intravenous.
* Antibiotic doses should be adjusted appropriately for patients with renal insufficiency or other dose-related considerations.
¶ If the patient is in septic shock or if Staphylococcus aureus is a concern (eg, in a patient with an indwelling catheter or prior injection drug use), we typically add vancomycin. Refer to other UpToDate content for vancomycin dosing.
Δ These regimens have anaerobic activity without the addition of metronidazole. Unless involvement of Entamoeba histolytica is unlikely (eg, in patients with obvious biliary disease predisposing to pyogenic abscess), metronidazole 500 mg IV or orally every eight hours should be added until the causative organism has been identified or amebic serology or antigen testing has come back negative.
◊ The dose of 4.5 g every six hours should be used when Pseudomonas coverage is desired.
§ Ticarcillin-clavulanate is not available in the United States or Canada and is of limited availability in other locations.
¥ Cefepime is an additional cephalosporin choice and has expected activity against Pseudomonas when used at a dose of 2 g IV every eight hours.
‡ We do not continue a gentamicin-containing regimen for pyogenic liver abscess beyond 48 to 72 hours. If microbiologic data are unrevealing and a gentamicin-containing regimen was used for empiric therapy, we switch to one of these other empiric regimens to complete the antibiotic course. Refer to other UpToDate content about details on dosing for parenteral aminoglycosides.
† Carbapenems are typically reserved for patients who should not use other options because of drug allergies or concern for resistant infection. Ertapenem lacks activity against Acinetobacter and Pseudomonas and, of the carbapenems, is not an appropriate choice for severe or nosocomial infection.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
