Lung abscess medical therapy: Difference between revisions

Jump to navigation Jump to search
(Category)
m (Bot: Removing from Primary care)
 
Line 40: Line 40:
== Reference ==
== Reference ==
{{Reflist|2}}
{{Reflist|2}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}


[[Category:Disease]]
[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Needs content]]
[[Category:Needs content]]
{{WikiDoc Help Menu}}
[[Category:Emergency mdicine]]
{{WikiDoc Sources}}
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Primary care]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Pulmonology]]

Latest revision as of 22:34, 29 July 2020

Abscess Main Page

Lung abscess Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Lung abscess from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Lung abscess medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Lung abscess medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Lung abscess medical therapy

CDC on Lung abscess medical therapy

Lung abscess medical therapy in the news

Blogs on Lung abscess medical therapy

Directions to Hospitals Treating Lung abscess

Risk calculators and risk factors for Lung abscess medical therapy

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.
  • 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).[2]
  • 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. [2]
  • 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).

Empiric

Pathogen directed

MSSA

MRSA

Actinomyces

  • Preferred regimen (1): Intravenous penicillin G (10 to 20 million units daily in divided doses every four to six hours) for 4 to 6 weeks

Nocardia .spp

  • Preferred regimen (1): TMP-SMX 15 mg/kg IV of the trimethoprim component per day in three or four divided doses plusAmikacin 7.5 mg/kg IV every 12 hours 

Fungi

Parasite

  • Preferred regimen (1): Albendazole is dosed 10 to 15 mg/kg per day in two divided doses; the usual dose for adults is 400 mg twice daily.one to three months may be appropriate, depending clinical factors; up to six months may be required.

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

Reference

  1. 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.
  2. 2.0 2.1 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.


Template:WikiDoc Sources