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]

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

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.

Empiric

• Preferred regimen (1): Ampicillin + Sulbactum  3g IV q6h
• Preferred regimen (2): Imipenem + Cilastin  500 mg IV q6h
• Preferred regimen (3): Meropenem 1-2 g IV q8h
• Alternative regimen (1):Clindamycin  IV 600 mg q8h

Pathogen directed

MSSA

• Preferred regimen (1): Nafcillin 2 g IV q4h
• Preferred regimen (2): Oxacillin 2 g IV q4h
• Preferred regimen (3): Cefazolin 2 g IV q8h

MRSA

• Preferred regimen (1): Linezolid 600 mg q12h IV/PO ± Rifampin 300 mg po/IV bid

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

• Preferred regimen (1): Amphotericin B  3-5mg/kg/day/IV

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