A lung abscess is a cavity within the substance of the lung filled with necrotic tissue, which occurs as a result of infection.
CAUSES
• The aspiration of infected mucus or tissue from the nose, mouth or pharynx especially in alcoholics, epileptics, unconscious or anaesthetised patients and following dental procedures.
• Persistent infection from any bacterial pneumonia
• Presence of a foreign body within the lung either by inhalation or penetrative lung injury
• Obstruction of an airway by tumour
• Septic emboli from other infected areas of the body e.g. from septicaemia and endocarditis
• Tuberculosis
• Staphylococcus aureus - usually presenting as multiple abscesses, especially in children
SYMPTOMS
• High swinging fever
• Breathlessness
• Cough, productive of copious amounts of foul smelling sputum.
• Haemoptysis - in over a third of cases.
SIGNS
• Fever
• Tachycardia
• Tachypnoea
• Chest wall tenderness
• Dull percussion note
• Poor air entry
INVESTIGATIONS
• FBC
• Chest X-ray
• Sputum culture
• Blood culture
TREATMENT
Non-Pharmacological
• Postural drainage
Pharmacological Treatment
Antibiotic management should include the following, until confirmation of organism by sputum culture:
Adults:
Flucloxacillin, IV, 500 mg 6 hourly for 14 days plus
Gentamicin, IV 40-80 mg 8 hourly for 14 days plus
Metronidazole, IV, 500 mg 8 hourly for 14 days
Children:
Flucloxacillin, IV,
<I year; |
62.5 mg 6 hourly for 14 days |
1-5 years; |
125 mg 6 hourly for 14 days |
5-12 years; |
250 mg 6 hourly for 14 days |
plus
Gentamicin, IV,
> 1 year; |
2.5 mg/kg BW 12 hourly for 14 days |
1-12 years; |
2.5 mg/kg BW 8 hourly for 14 days |
plus
Metronidazole, IV, 7.5 mg/kg BW 8 hourly for 14 days
REFER
Refer to a Physician or a higher level medical facility.
