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
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
Ciprofloxacin 500mg PO BID
Moxifloxacin 400mg PO Q24H
Amoxicillin 500mg PO TID
all
with or without Metronidazole 500mg PO BID
Entamoeba histolytica
