Lung Abscess Treatment, causes, symptoms, investigations
Lung Abscess Causes:
Predisposing condition- Aspiration of oropharyngeal secretions in alcohol or drug use, seizures, CNS disease, general anesthesia, poor dental hygiene, periodontal disease, nocturnal asthma, bronchiectasis, chemical pneumonitis, pleuropulmonary infection, foreign body obstruction of airways, etc.
Anaerobic bacteria Prevotella melaninogenica, Fusobacterium nucleatum, Peptostreptococcus, and Bacteroides species commonly seen, sometimes aerobic bacteria too.
Lung Abscess Symptoms:
fever, malaise, weight loss. Cough with expectoration, foul smelling purulent sputum (in anaerobic infection).
Lung Abscess Investigations:
Transthoracic aspiration, thoracentesis, or bronchoscopy used for culture of anaerobic bacteria.
X-ray Chest show- air-fluid level in thick-walled cavity and surrounded with consolidation.
CT chest in few cases.
Lung Abscess Treatment:
I/V Clindamycin 600 mg Q 8 H upto improvementthen occurs then Tablet 300 mg 6 hourly QID. Or Tab. Amoxicillin-clavulanate (875 mg/125 mg BD).
Or Tab. Amoxicillin, 500 mgTID plus Tab. Metronidazole 500 mg QID, continue treatment till X-ray improves. Treatment may take a month or more sometimes.
Supportive & symptomatic care.
Treatment of Predisposing conditions (mentioned above). We will discuss them all separately.
severe cases- I/V Piperacillin-Tazobactum 4.5 gm Q 8 Hourly plus
I/V Amikacin 750 mg once daily plus
I/V Metronidazole 500mg three to four times a day.
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