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]

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		Age group specific therapy
		Adult
Empiric	Anaerobes and microaerophilic streptococci	Ampicillin +sulbactum  3g IV q6h (or)        Imipenem+cilastin  500 mg IV q6h (or)         Meropenem    1-2 g IV q8h
	Alternnative	Clindamycin  IV 600 mg q8h 150 to 300 mg orally four times daily
Pathogen directed	MSSA	Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h OR Cefazolin 2 g IV q8h
	MRSA	Linezolid 600 mg q12h IV/PO ± Rifampin 300 mg po/IV bid sue=9725 |pages=1557–68 |year=2010 |pmid=20206987 |pmc=3511788 |doi=10.1016/S0140-6736(09)61999-1 |url=}}</ref>
	Actinomyces	Intravenous penicillin G (10 to 20 million units daily in divided doses every four to six hours) for 4 to 6 weeks,
	Nocardia .spp	TMP-SMX 15 mg/kg IV of the trimethoprim component per day in three or four divided doses  PLUS Amikacin 7.5 mg/kg IV every 12 hours
	Fungi	Amphotericin B  3-5mg/kg/day/IV
	Parasite	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 a ppropriate, depending clinical factors; up to six months may be required.

• Clinical improvement is reflected in the subsidence of fever (within the first 3-4 days) and complete defervescence 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, transdermal or surgical lung biopsy).
• 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.
• 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).