Q:

Which of the following statement(s) is/are true concerning treatment of pyogenic liver abscess?

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Which of the following statement(s) is/are true concerning treatment of pyogenic liver abscess?


  1. Antibiotic therapy alone may be advisable in patients with multiple small abscesses
  2. Percutaneous drainage provides comparable results to surgical drainage in patients with unilocular large abscesses
  3. Sufficient antibiotic coverage for most hepatic abscesses includes coverage for gram-positive aerobic bacteria only
  4. In patients with a primary biliary origin for the hepatic abscess, treatment must also be addressed at underlying biliary pathology such as choledocholithiasis or biliary ductal obstruction

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a. Antibiotic therapy alone may be advisable in patients with multiple small abscesses

b. Percutaneous drainage provides comparable results to surgical drainage in patients with unilocular large abscesses

d. In patients with a primary biliary origin for the hepatic abscess, treatment must also be addressed at underlying biliary pathology such as choledocholithiasis or biliary ductal obstruction

The preferred treatment of most patients with hepatic abscesses is broad-spectrum antibiotic coverage and drainage. A number of studies have demonstrated for most patients with large unilocular abscesses that percutaneous catheter drainage is as effective as surgical drainage. Bacteria that predominate in pyogenic liver abscesses are gram-negative aerobes, streptococcal species, and anaerobes. Therefore, broad-spectrum antibiotic coverage is necessary. Antibiotic coverage alone may be advisable in occasional patients who have multiple small abscesses not accessible to percutaneous or surgical drainage. Since many of these patients have an underlying biliary pathology as the source of the hepatic abscess, correcting this underlying pathology, for example, establishing biliary drainage surgically or nonoperatively is important.

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