Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

920 Lung Abscess

■If not connected with a bronchus, may have no air-fluid level and

appear like consolidation

■Chest CT can usually distinguish parenchymal abscess from pleural

fluid/empyema

management

What to Do First

■Assess hemodynamic status, oxygenation and need for admission

General Measures

■Start IV antibiotics; continue 4–8 d or until afebrile and stable

specific therapy

Indications

■All pulmonary abscesses require antibiotics

■If abscess fails to respond or is in an unusual location proceed to

bronchoscopy to rule out endobronchial lesion

Treatment Options

■Antibiotics: clindamycin preferred because of effectiveness and cost

■Alternative antibiotics:

➣Penicillin and metronidazole in combination

➣Cefoxitin

➣Ticarcillin/clavulanate

➣Piperacillin/tazobactam

■Drainage: important for resolution:

➣Postural drainage generally sufficient

➣Nasal tracheal suctioning sometimes needed for patients without

cough

➣Bronchoscopy if patient fails to respond and suspicion of under-

lying endobronchial lesion or foreign body

➣Percutaneous drainage under CT guidance if not improving and

ongoing sepsis

■Surgical resection: reserved for massive hemoptysis, unresponding

sepsis or respiratory failure

Side Effects & Complications

■Antibiotics:

➣Side effects: diarrhea

➣Complications: pseudomembranous colitis/ C dificile colitis par-

ticularly with clindamycin

➣Contraindications: absolute: hypersensitivity to antibiotic