Advances in diagnosis and therapy have significantly improved the outcome of patients with pyogenic liver abscess. Recent data indicate that the initial management strategy for the vast majority of these patients should be via a percutaneous approach. However, antibiotics alone or surgical approaches are an option for selected patients. Amebic liver abscess in the United States is seen primarily in patients from areas in which Entamoeba histolytica is endemic. Its diagnosis rests primarily on strong clinical suspicion, which can be rapidly confirmed with imaging procedures and serologic tests. Treatment of amebic liver abscess with antimicrobial agents is highly effective. Hepatic echinococcal disease (hydatid disease of the liver) is a serious infection that is most often imported into the United States. Management of this disease requires an integrated medical, radiologic, and surgical approach. The role of prophylactic antibiotics for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is controversial. A recent well-designed study found that single-dose prophylaxis with piperacillin was not associated with a clinically significant benefit in patients undergoing ERCP for the evaluation of suspected biliary stones or distal common bile duct stricture.
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