From the Guidelines
Percutaneous catheter drainage (PCD) is the recommended initial treatment for intraabdominal abscesses, particularly for mature abscesses associated with appendicitis, with a reported efficacy ranging from 70% to 90% 1. The primary goal of treatment is source control, which can be achieved through PCD guided by CT or ultrasound, or surgical drainage if percutaneous approaches are not feasible.
- Empiric broad-spectrum antibiotics should be started immediately, typically including piperacillin-tazobactam 3.375g IV every 6 hours, meropenem 1g IV every 8 hours, or a combination of metronidazole 500mg IV every 8 hours plus either ceftriaxone 2g IV daily or ciprofloxacin 400mg IV every 12 hours.
- Antibiotic therapy should be adjusted based on culture results and continued for 4-7 days after adequate drainage and resolution of clinical symptoms.
- Patients require close monitoring for signs of sepsis, with vital signs checked regularly and laboratory tests including complete blood count, comprehensive metabolic panel, and C-reactive protein to track improvement.
- Nutritional support may be necessary, particularly in prolonged cases.
- Follow-up imaging is recommended to confirm resolution of the abscess. The classification of intra-abdominal infections into complicated and uncomplicated cases can guide treatment decisions, with uncomplicated cases potentially not requiring post-operative antibiotic therapy 1.
- However, the treatment of choice for intraabdominal abscesses, as recommended by the most recent and highest quality study, is Percutaneous Catheter Drainage Only 1.
From the FDA Drug Label
Piperacillin and Tazobactam for Injection is indicated in adults and pediatric patients (2 months of age and older) for the treatment of appendicitis (complicated by rupture or abscess) and peritonitis caused by beta-lactamase producing isolates of Escherichia coli or the following members of the Bacteroides fragilis group: B. fragilis, B. ovatus, B. thetaiotaomicron, or B. vulgatus.
The treatment for intraabdominal abscess is Piperacillin-Tazobactam (IV) as it is indicated for the treatment of appendicitis complicated by abscess.
- The usual total daily dosage is 3.375 grams every six hours, totaling 13.5 grams (12.0 grams piperacillin and 1.5 grams tazobactam) 2.
- The usual duration of treatment is from 7 to 10 days. No information is provided about the use of Cefepime (IV) for the treatment of intraabdominal abscess 3.
From the Research
Treatment of Intraabdominal Abscess
- Prompt recognition, early localization, and effective drainage are essential for the management of intraabdominal abscesses, along with appropriate antimicrobial use 4
- Broad-spectrum antibiotics should be given until culture and sensitivity data are obtained, and then therapy with appropriate coverage should be chosen 4
- Percutaneous or open surgical drainage should be used, depending on the location and characteristics of the abscess 4
- Piperacillin/tazobactam is a suitable antibiotic for the treatment of intraabdominal infections, including abscesses, due to its broad-spectrum activity and low toxicity 5, 6, 7, 8
Antibiotic Selection
- Piperacillin/tazobactam, cefepime, and metronidazole can provide adequate concentrations in abscesses, except for the largest ones 5
- Vancomycin and ciprofloxacin levels are often inadequate in abscesses 5
- Fluconazole may require higher doses in abscesses 5
- The choice of antibiotic should be guided by culture and sensitivity data, as well as the severity and location of the abscess 4
Drainage and Surgical Intervention
- Percutaneous drainage is a suitable option for many abscesses, but may be inappropriate for abscesses in certain locations, such as the posterior subphrenic space or porta hepatis 4
- Open surgical drainage may be necessary for abscesses that are not accessible by percutaneous drainage or that require surgical intervention 4
- Surgical intervention should be performed promptly, as delayed treatment can lead to increased morbidity and mortality 4