12.6 Lung Abscess
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Primary lung abscess* (In patients with previously healthy lungs and no underlying structural lung disease) | Inj Clindamycin 600mg IV q8h Or Inj Amoxicillin- clavulanate 1.2g IV q8h | Inj Piperacillin- tazobactam 4.5g IV q6h Or Cefoperazone- sulbactam 3g IV q12h | Consider source control in the form of drainage. Change to targeted therapy as per culture results of pus/ sputum / BAL. Switch to oral as and when patient is stable and able to take orally. Treat for 4-6 weeks. |
| Secondary Lung Abscess** (in patients with conditions causing obstruction of airways: eg: malignancies) | Inj Piperacillin- tazobactam 4.5g IV q6h Or Cefoperazone- sulbactam 3g IV q12h | Imipenem- cilastatin 500 mg IV q6h Or Meropenem 1g IV q8h | Change to targeted therapy as per culture result of pus/ sputum / BAL. Treat for 4-6 weeks. |
For common etiological agents of Lung Abscess, see Annexure B.12.6
Additional Information
*Primary Lung abscess: due to aspiration of oropharyngeal secretions - dental/periodontal infection, para nasal sinusitis, altered states of consciousness, necrotizing pneumonia or in immunocompromised patients
**Secondary Lung abscess: due to bronchial obstructions (by tumor, foreign body or enlarged lymph nodes), with coexisting lung diseases (bronchiectasis, infected pulmonary infarcts), spreading from
extrapulmonary sites-hematogenous (abdominal sepsis, infective endocarditis, septic thromboembolism) direct spread (broncho-oesophageal fistula, subphrenic abscess)
References
1. Kuhajda I, Zarogoulidis K, Tsirgogianni K, et al. Lung abscess-etiology, diagnostic and treatment options. Ann Transl Med. 2015;3(13):183. doi:10.3978/j. ISSN.2305-5839.2015.07.08
2. Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, Tsakiridis K, Mpakas A, Zarogoulidis P, Zissimopoulos A, Baloukas D, Kuhajda D. Lung abscess-etiology, diagnostic and treatment options. Ann Transl Med. 2015 Aug;3(13):183. doi: 10.3978/j. ISSN.2305- 5839.2015.07.08. PMID: 26366400; PMCID: PMC4543327.