4.8 Splenic Abscess
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Splenic Abscess, stable hemodyamics | Defer antibiotics till microbiological diagnosis made from blood or splenic aspirate | The culture results guide the choice of antibiotics. Splenic abscesses are most regularly seen as complications of infective endocarditis, in about 5% of patients. Duration of therapy: 3-4 weeks | |
| Splenic abscess, patient in shock or unstable | Meropenem 1g IV q8h + Vancomycin 1g IV q12h |
Teicoplanin (alternative to Vancomycin) Loading dose of 400 mg q12h IV for three doses then 400 mg IV q24h |
Duration of therapy: 3-4 weeks |
For common etiological agents of Splenic Abscess, see Annexure B.4.8
Additional Information
- The gold standard for treating a splenic abscess is splenectomy; however, recent studies have shown success using different approaches based on abscess characteristics.
- Percutaneous aspiration may be a less invasive option in patients at high risk for surgery or a temporary solution used as a bridge to surgery, avoiding the risk of a fulminant and potentially life-threatening infection.
- Percutaneous aspiration is a successful approach when the abscess collection is unilocular or bilocular, with a complete and thick wall and no internal septations. Aspiration is easier to achieve when the content is liquid enough to be drained. If there are multiple collections or associated coagulopathy, either laparoscopic or open surgical treatment is preferred.