Management
Postural drainage is important in the management of a lung abscess. The most satisfactory position is determined by radiological localisation.
Antibiotics therapy depends on the organism:
- beta-lactamase inhibitors (eg, ticarcillin-clavulanate, ampicillin-sulbactam, amoxicillin-clavulanate, and piperacillin-tazobactam) are the preferred initial empiric antibiotic therapy followed by imipenem or meropenem. (1)
- definitive treatment, for example:
- flucloxacillin for staphylococcus. Medical treatment is often successful but healing may take several weeks.
Percutaneous drainage of a lung abscess is usually reserved for patients in whom the abscess cavity does not communicate with the bronchus or those in whom medical treatment and physiotherapy fails. (2)
Surgery or interventional drainage should occur in patients with non-resolving abscesses (particularly if associated with empyema), resistance to medical treatment, significant haemorrhage, or large abscesses (>6 cm). Foreign bodies and some cavitating tumours may also be removed surgically. (3)
Reference
- Walters J, Foley N, Molyneux M. Continuing education in anaesthesia, critical care and pain: pus in the thorax: management of empyema and lung abscess. 2011 Dec 1;11(6):229-33.
- Kuhajda I et al. Lung abscess-etiology, diagnostic and treatment options. Ann Transl Med. 2015 Aug;3(13):183.
- American College of Radiology. ACR appropriateness criteria: radiologic management of infected fluid collections. 2019 [internet publication]
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