Fluoroquinolones and third-generation cephalosporins should be first-line antibiotics for liver cyst infections and ‘preferably’ used for six weeks, new guidance says.

An international panel of 24 specialists — including 12 hepatologists — has also advised clinicians to use fever, CRP level and leukocyte concentration to evaluate treatment effect, but urged caution when considering aspiration.

Their clinical decision framework provides the first expert consensus on managing cyst infections in patients with isolated cysts or polycystic liver disease.

“This framework will facilitate uniformity in the management of liver cyst infections and can constitute the basis for the development of future guidelines,” they wrote in The Lancet Gastroenterology and Hepatology last month.