Treatment of liver abscess with S.aureus

• One of the common organisms in liver abscess
• Not commonly recommended as monotherapy in liver abscess due to polymicrobial nature of disease and poor microorganism yield in C&S results.
• Most guides recommend usage of combination antibiotics
• Choice of antibiotics/regimen with S.aureus coverage

Unasyn	Good coverage of Gram-positive, Gram-negative, and anaerobic pathogens - lacks Pseudomonas aeruginosa coverage but goodEnterococcus species coverage. Rising rates of resistance in E. colimean that this is no longer a favored empiric choice, but may be quite acceptable once culture results have returned
Cefepime	Excellent coverage of gram negative w/ some Gram positive pathogens; use in combination with anaerobic agent for empiric therapy
Imipenam/Cilastin Meropenam	Excellent broad spectrum (Gram-positive, Gram-negative, and anaerobe) coverage; would reserve for seriously ill patients. Has better coverage for E. faecalis than meropenem or doripenem; none of the carbapenems cover E. faecium
Tazocin	Excellent broad spectrum coverage including Gram-positive and Gram-negative coverage (includingPseudomonas aeruginosa and β-lactamase producing pathogens) and anaerobic coverage.
Cloxacillin	Commonly only seen as part of combination treatment in children
Vancomycin	seen as part of combination treatment in children, to those not responding to Cloxacillin previously
Ampicilin	As part of combination regimen with gentamicin and metronidazole

* the shaded agents are the recommended agents for adults base on recent guidelines

** Ampicillin use is based on NAG 2008

*** Cloxacillin is seen usually in management of Liver Abscess in Children

REFERENCES:

1. Liver Abscess. http://www.jfmpc.com/article.asp?issn=2249-4863;year=2013;volume=2;issue=2;spage=206;epage=208;aulast=Shah
2. http://bestpractice.bmj.com/best-practice/monograph/640/treatment/step-by-step.html
3. PYOGENIC LIVER ABSCESS IN CHILDREN. http://acta.tums.ac.ir/index.php/acta/article/viewFile/2715/2403
4. Hepatic Abscess. http://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540259/all/Hepatic_Abscess