Pyogenic liver abscess is an important and often life-threatening disorder. It is commonly caused by underlying disease of the biliary system, but more frequently, no predisposing disorder can be identified. Its diagnosis requires a high index of suspicion and imaging of the liver. The optimal treatment of pyogenic liver abscess is percutaneous drainage and intravenous broad-spectrum antibiotics with activity against enteric aerobic and anaerobic bacteria. Blood and abscess cultures should be obtained and amebic liver abscess carefully eliminated when the diagnosis is in doubt. Surgical drainage, preferably laparoscopic, is reserved for patients with complicated abscesses or after failure of response to initial medical therapy. Possible primary predisposing conditions to pyogenic liver abscess, such as biliary tract disorders, should be sought and managed accordingly. Intravenous antibiotics should be administered for a period of 2 weeks, followed by a more prolonged course of oral antibiotics. The choice and duration of antibiotic therapy, and the need for further intervention are determined by microbiologic data, the patient's clinical response, and repeated imaging studies.