Lung Abscess

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Lung abscess is a cavity within the lung parenchyma filled with necrotic tissues, which occurs as a result of tissue-destroying infection.

Clinical presentation

It is characterized by high fever, breathlessness, cough productive of large amounts of foul-smelling sputum and haemoptysis.

Investigation

FBP, ESR, CXR, Sputum Analysis (Gram Stain, Cytology, Gene Xpert, Culture), Blood Culture, CT Chest, Bronchoscopy, Sputum for ova and parasite (if parasitic cause is suspected).

Non-pharmacological Treatment

Postural drainage

Pharmacological Treatment

B: ampicillin + cloxacillin (FDC)(IV) 500–1000mg for 7days then (PO) 8hourly for 3–6weeks (children 50mg/kg/dose)

AND

B: metronidazole (IV) 500mg 8hourly for 7days then (PO) 400mg 8hourly for 4–6weeks (children 7.5mg/kg)

Note: The duration of antibiotics therapy depends on the clinical and radiographic response of the patient, but completely healing, with radiographic normalization can be seen after two months. Refer patient to specialized unit if large cavity size (ie, >6cm in diameter), persistent fever.

D: ceftriaxone + sulbactam (FDC) (IV) 1.5-3g 6hourly 4-6weeks

OR

S: clindamycin (IV) 600mg 8hourly for 7days and then (PO) 300mg 8hourly 4-6weeks

OR

S: piperacillin + tazobactam (FDC) (IV) 4.5g 6hourly 4-6weeks

OR

S: meropenem (IV) 1g 8hourly for 4-6 weeks