Introduction

Prompt empirical antimicrobial treatment with or without percutaneous aspiration or drainage is therapeutic for liver abscess. The rational for using empirical intravenous broad-spectrum antimicrobials upfront instead of oral Fluoroquinolone or Cephalosporin is contentious.

Aim

To evaluate and compare the efficacy of empirical oral Ciprofloxacin or Cefixime plus Metronidazole therapy for the treatment of uncomplicated liver abscess

Patient Profile

Newly diagnosed patients (age ≥ 18 years) of liver abscess confirmed with radiology imaging

Methods

• Study conducted in post graduate institute of medical education and research (PGIMER), a tertiary care centre in northern India
• Randomized double blind controlled clinical trial

Study endpoints

Primary

Clinical cure (defined as asymptomatic and afebrile for >48 h, along with USG showing no drainable collection in the liver with removal of the pigtail catheter if any)

Secondary

Treatment failure, duration of therapy, need for prolonged antibiotic therapy, duration of hospital stay, recurrence of liver abscess, all-cause mortality, incidence of complication, need for surgical intervention, compliance to the therapy, adverse drug events

Results

Clinical Cure: 89.3% of participants achieved clinical cure. Clinical cure was more in Cefixime group compared to Ciprofloxacin group (93.0% vs. 85.5%), the difference was not statistically significant (p = 0.154)

Mean duration of antimicrobial therapy: Total mean of 16.2 ± 4.3 days; 15.1 ± 4.5 days in Ciprofloxacin group and 16.0 ± 4.2 days in Cefixime group (p = 0.223)

Mean (± SD) duration of hospital stay: 1.6(0.6) days, which was similar between the groups (p = 0.210)

Treatment failure: 10.7% participants had treatment failure; 14.5% in Ciprofloxacin group and 7.0% in Cefixime group (p = 0.154). Most common reason for treatment failure was need of prolonged (> 4 weeks) antimicrobial therapy due to persistent hepatic collection requiring drainage, which was significantly higher in Ciprofloxacin group compared to Cefixime group (14.5% vs. 4.2%, p = 0.036)

Compliance: Overall compliance to the therapy was very good. It was inadequate in only 3.6% participants due to side effects

Safety: Both the drugs were well tolerated, and no serious adverse events were observed during the 8 weeks of follow up

Conclusion

• For treatment of uncomplicated liver abscess, both, Ciprofloxacin or Cefixime plus Metronidazole for duration of 2–3 weeks were similarly efficacious empirical oral antimicrobial regimens along with prompt percutaneous drainage/aspiration
• Oral Cefixime had lesser chance of treatment failure than Ciprofloxacin due to persistent collection leading to prolonged antibiotic therapy, but it needs further investigation in larger trials

Reference

Sci Rep. 2024 May 20;14(1):11430