Lung abscess management

Lung abscess management

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

Clinical presentation

Lung abscess is characterized by:

• High fever

• Breathlessness

• Cough productive of large amounts of foul-smelling sputum

• Haemoptysis

Investigations

• FBP

• ESR

• CXR

• Sputum analysis:

  • Gram stain

  • Cytology

  • GeneXpert

  • Culture

• Blood culture

• CT chest

• Bronchoscopy

• Sputum for ova and parasites (if a parasitic cause is suspected)

Non-pharmacological treatment

• Postural drainage

Pharmacological treatment

First-line regimen

• Ampicillin + Cloxacillin (FDC) (IV) 500–1000 mg for 7 days, then (PO) every 8 hours for 3–6 weeks

  Children: 50 mg/kg/dose

AND

• Metronidazole (IV) 500 mg every 8 hours for 7 days, then (PO) 400 mg every 8 hours for 4–6 weeks

  Children: 7.5 mg/kg/dose

Alternative regimens

Option 1

• Ceftriaxone + Sulbactam (FDC) (IV) 1.5–3 g every 6 hours for 4–6 weeks

OR

Option 2

• Clindamycin (IV) 600 mg every 8 hours for 7 days

Then

• Clindamycin (PO) 300 mg every 8 hours for 4–6 weeks

OR

Option 3

• Piperacillin + Tazobactam (FDC) (IV) 4.5 g every 6 hours for 4–6 weeks

OR

Option 4

• Meropenem (IV) 1 g every 8 hours for 4–6 weeks