1. Pyogenic liver abscess

• IV broad-spectrum antibiotics are started promptly, then adjusted to blood and abscess culture results.
• Image-guided drainage by radiology, usually percutaneous needle aspiration or a catheter, is commonly needed for source control.
• Surgery is generally reserved for failed percutaneous treatment, rupture, multiple difficult abscesses, or when the underlying source also needs surgery.
  Maingot's Abdominal Operations, p. 930.
• Doctors also investigate and treat the cause, such as bile-duct obstruction/cholangitis, gallbladder disease, appendicitis/diverticulitis, or infection elsewhere.

2. Amoebic liver abscess

• First-line treatment is an anti-amoebic drug, usually metronidazole or tinidazole.
• This must be followed by a luminal amoebicide such as paromomycin or iodoquinol to clear intestinal cysts. Metronidazole alone does not reliably do that.
  Harrison's Principles of Internal Medicine, 22e, p. 1801.
• Drainage is not routine in uncomplicated cases, but may be needed if diagnosis is uncertain, there is no improvement, the abscess is large/high-risk for rupture, or complications develop.
  Maingot's Abdominal Operations, p. 930. The Merck amebiasis guidance likewise recommends a tissue-active drug followed by a luminal agent.

Seek emergency care now if there is

• High fever or chills
• Severe right-upper abdominal pain
• Confusion, fainting, low blood pressure, or fast heartbeat
• Jaundice
• Shortness of breath, persistent vomiting, or worsening pain