Good coverage of Gram-positive, Gram-negative, and anaerobic pathogens; lacks Pseudomonas aeruginosa coverage but good Enterococcus species coverage. Rising rates of resistance in E. coli mean that this is no longer a favored empiric choice, but may be quite acceptable once culture results have returned.
Excellent coverage of Gram-negative w/ some Gram-positive pathogens; use in combination with anaerobic agent for empiric therapy.
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.
Excellent broad spectrum (Gram-positive, Gram-negative, and anaerobe) coverage; would reserve for seriously ill patients. Will cover E. faecalis; none of the carbapenems cover E. faecium.
Newer carbapenem approved recently for complicated IAIs. Excellent Gram-positive (except E. faecium), Gram-negative and anaerobic coverage.
Excellent broad-spectrum coverage includes some anaerobic activity, many would still use with metronidazole with liver abscess condition due to resistance among B. fragilis.
Excellent broad spectrum coverage including Gram-positive and Gram-negative coverage (including Pseudomonas aeruginosa and β-lactamase producing pathogens) and anaerobic coverage.
Broad spectrum coverage including Gram-positive coverage, Gram-negative coverage (including Pseudomonas aeruginosa [but less active than piperacillin/tazobactam] and B-lactamase producing pathogens) and anaerobic coverage. No longer available in the U.S. marketplace.
Remains premier anti-anaerobic drug, and preferred for pyogenic abscesses in combination therapy, also treats amebic liver infection.
Broad spectrum agent related to minocycline, with excellent gram-positive (including MRSA and VRE), Gram-negative (except Pseudomonas aeruginosa and Proteus mirabilis) and anaerobic activity, approved for complicated intraabdominal infections.
First-, second-, or third-generation cephalosporins
Entamoeba histolytica (amebic liver abscess)
Surgical resection or PAIR procedure
Comment: Recommendations in this module are based on literature given lack of robust RCT data and guideline statements.
Comment: Authors divide hepatic abscesses into three categories: infectious, iatrogenic and those associated with malignancy.
Comment: Review of five RCTs suggests catheter drainage preferred over simple aspiration as it is correlated with higher success rates, faster resolution of cavity size.
Provides an overview of clinical features and management of hepatic abscesses caused by Klebsiella.
Comment: No RCTs identified to support or refute role of PAIR procedure with or without benzimidazole for hydatid cysts.
Comment: Contains a review of pyogenic (including a breakdown of pyogenic causes and microbiology) and parasitic (including hydatid cyst and amoebic) liver abscesses.
Comment: Review of imaging of hepatic abscesses and other hepatic infections.
Comment: Predictive factors for early aspiration in liver abscess
Comment: Review of the most common infectious causes of abscess disease in the liver.
Comment: Compares catheter drainage versus needle aspiration.
Comment: Consensus, evidence-based general guidelines from IDSA, SIS, ASM, and SIDP.
Comment: Association of underlying parasitic disease and superinfection with bacteria.
Comment: Study suggests aspiration for large abscesses (>5-10 cm) plus MTZ hastens resolution and appears to be safe to perform.
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