The most effective management of a subphrenic abscess is drainage. This may be achieved under ultrasound control or via an open operation.
If the abscess is diagnosed early and has no air or fluid level then this may be treated with broad-spectrum antibiotics, e.g. gentamicin, benzylpenicillin, and metronidazole. If the patient remains symptomatic for more than 5 days then conservative management should be abandoned and abscess drainage performed.
Note that gentamicin levels should be measured regularly and doses of gentamicin should be reduced if there is renal impairment.
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