Sequential intravenous/oral antibiotic vs. continuous intravenous antibiotic in the treatment of pyogenic liver abscess

Abstract

SUMMARYAim: Pyogenic liver abscesses result in substantial morbidity and mortality. Antimicrobial regimens using sequential intravenous=oral therapy may reduce the length of hospital stay. In this retrospective analysis, the efficacy of continuous intravenous antibiotic therapy (group I) vs. sequential intravenous=oral antibiotic therapy (group II) was studied in patients with pyogenic liver abscess. Methods: One hundred and twelve consecutive patients (55 in group I and 57 in group II) with pyogenic liver abscess were analysed. Clinical response, length of hospital stay and relapse rates were examined.Results: Group II had a significantly shorter duration of intravenous antibiotic treatment (3.2 weeks vs. 5.9 weeks, P < 0.01) and a shorter length of hospital stay (28 days vs. 42 days, P < 0.01) when compared to group I. Oral antibiotics were prescribed for a median duration of 2.9 weeks in group II after discharge. No relapse occurred within 6 weeks after the completion of treatment in both groups. The cost of therapy was significantly lower in group II than in group I by 33%. Conclusions: A sequential intravenous=oral antibiotic regime is a safe and effective treatment for pyogenic liver abscess. This reduces the cost of therapy and the length of hospital stay.

National Trends in Health Care Utilization and Racial and Socioeconomic Disparities in Pediatric Pyogenic Arthritis

“…19 Other investigations have reported to reduce both LOS and charges. For instance, treating pyogenic liver abscesses with sequential intravenous/oral antibiotics as opposed to treating them with continuous intravenous antibiotics reduced both LOS 20 Similarly, treating gram-positive infections with intravenous linezolid followed by oral administration was found to reduce the LOS and the associated cost of treatment when compared with intravenous or intramuscular teicoplanin. 21 Conversely, we found that although efforts to reduce the LOS associated with pyogenic arthritis have been successful, they have not resulted in decreased hospital charges.…”

Transition to Oral versus Continued Intravenous Antibiotics for Patients with Pyogenic Liver Abscesses: A Retrospective Analysis

“…One retrospective study found that transitioning to PO antibiotics decreased the cost of therapy and decreased the length of hospital stay for patients with pyogenic liver abscesses. 26 Key differences between our study and this one are that 80% of the patients had a single pyogenic liver abscess caused by Klebsiella pneumonia, and not all of the patients underwent drainage of their abscess. One prospective randomized controlled trial compared IV antibiotic therapy with sequential IV-to-PO antibiotic therapy in the treatment of complicated intraabdominal infections.…”

A case of pyogenic liver abscess in a 10-year-old girl

“…In adults, antibiotic therapy is recommended intravenously for at least 2 weeks and then orally for up to 6 weeks6, 7). In a recent report on PLA in adults, sequential intravenous therapy for 3 weeks followed by oral antibiotics for 3 weeks was safe and equally effective compared with 6-week intravenous antibiotic therapy10). According to another report in children, when percutaneous continuous drainage is maintained during 2 to 4 weeks, parenteral antibiotic therapy should also be maintained for at least 2 to 4 weeks, followed by oral antibiotics for a total of 4 to 6 weeks3).…”