Lung abscess medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
The mainstay of management for lung abscess is: hospital admission for chest drain and systemic antibiotics. Antimicrobial therapy is based on predisposing host factors and local resistance patterns.The standard duration of the treatment of lung abscess is ≥ 4–6 weeks of parenteral antibiotics[1]
Medical Therapy
- Empiric treatment should be commenced after culture samples are obtained.
- The choice of empiric antibiotics should be determined on the basis of the possible risk of multi-drug resistant causative bacteria, and culture results.
The following table summarizes the treatment for Lung abscess
| Pathogens | Antibiotic regimen | |
|---|---|---|
| Empiric | Anaerobes and microaerophilic streptococci |
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| Alternative[3] |
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| Pathogen directed | MSSA | |
| MRSA | ||
| Actinomyces |
| |
| Nocardia .spp |
| |
| Fungi |
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| Parasite |
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- Metronidazole should never be given alone, as it is inactive against microaerophilic strains, aerobic streptococci, and Actinomyces species.
- Metronidazole in combination with penicillin is given due to the observed failure of penicillin to cure penicillin-resistant Prevotella melaninogenica, Porphyromonas asaccharolytica, and Bacteroides species.
- Patients allergic to penicillin and cephalosporins may be treated with clindamycin combined with aztreonam, ciprofloxacin or levofloxacin for coverage of gram-negative pathogens
- Clinical improvement is reflected in the subsidence of fever (within the first 3-4 days) and complete abatement of fever occurs within 7-10 days. Persistent fever can be explained by treatment failure due to uncommon pathogens (multidrug resistant common bacteria, mycobacteria, fungi)or by the presence of an alternative diagnosis (e.g. endobronchial obstruction, vasculitis) that requires further diagnostic workup (e.g. bronchoscopy or surgical lung biopsy).[5]
- The duration of treatment with antibiotics is not well defined, according to many experts, the optimal duration of antimicrobial therapy is 3-6 weeks, whereas others take the timing of radiological response into consideration. [5]
- In that case, the length of antibiotic treatment depends on complete radiological resolution or stabilization to a small residual lesion.
- Treatment interval may then be prolonged to several months (more than 2),6 especially when the initial lesion is of large size (maximum diameter more than 6cm).
Reference
- ↑ Allewelt M, Schüler P, Bölcskei PL, Mauch H, Lode H (2004). "Ampicillin + sulbactam vs clindamycin +/- cephalosporin for the treatment of aspiration pneumonia and primary lung abscess". Clin. Microbiol. Infect. 10 (2): 163–70. PMID 14759242.
- ↑ Germaud P, Poirier J, Jacqueme P, Guerin JC, Benard Y, Boutin C, Brambilla C, Escamilla R, Zuck P (1993). "[Monotherapy using amoxicillin/clavulanic acid as treatment of first choice in community-acquired lung abscess. Apropos of 57 cases]". Rev Pneumol Clin (in French). 49 (3): 137–41. PMID 8296141.
- ↑ Levison ME, Mangura CT, Lorber B, Abrutyn E, Pesanti EL, Levy RS, MacGregor RR, Schwartz AR (1983). "Clindamycin compared with penicillin for the treatment of anaerobic lung abscess". Ann. Intern. Med. 98 (4): 466–71. PMID 6838068.
- ↑ DeLeo FR, Otto M, Kreiswirth BN, Chambers HF (2010). "Community-associated meticillin-resistant Staphylococcus aureus". Lancet. 375 (9725): 1557–68. doi:10.1016/S0140-6736(09)61999-1. PMC 3511788. PMID 20206987.
- ↑ 5.0 5.1 Takayanagi N, Kagiyama N, Ishiguro T, Tokunaga D, Sugita Y (2010). "Etiology and outcome of community-acquired lung abscess". Respiration. 80 (2): 98–105. doi:10.1159/000312404. PMID 20389050.