Chest CT is the preferred radiographic study for precise delineation of the lesion.
- It is not clear whether invasive diagnostics (e.g., transtracheal aspiration) to identify an etiologic agent in primary lung abscesses is helpful.
- Sputum and blood cultures, serologic studies for opportunistic pathogens, and—if needed—more invasive methods of sample collection (e.g., bronchoalveolar lavage, CT-guided percutaneous aspiration) are recommended for secondary lung abscesses or when empirical therapy fails.
Treatment: Lung Abscess Treatment depends on the presumed or established etiology. - For primary lung abscesses, the recommended regimens are clindamycin (600 mg IV tid) or an IV-administered β-lactam/β-lactamase combination. After clinical improvement, the pt can be transitioned to an oral regimen (clindamycin, 300 mg qid; or amoxicillin/clavulanate).
- In secondary lung abscesses, antibiotic coverage should be directed at the identified pathogen.
- Continuation of oral treatment is recommended until imaging shows that the lung abscess has cleared or regressed to a small scar.
- Pts who continue to have fever ≥7 days after antibiotic initiation and whose additional diagnostic studies fail to identify an another treatable pathogen may require surgical resection or percutaneous drainage of the abscess.
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For a more detailed discussion, see Mandell LA, Wunderink RG: Pneumonia, Chap. 153, p. 803; Baron RM, Baron Barshak M: Lung Abscess, Chap. 154, p. 813; and Baron RM, Baron Barshak M: Bronchiectasis, Chap. 312, p. 1694, in HPIM-19. |