Makindo Medical Notes"One small step for man, one large step for Makindo" |
|
---|---|
Download all this content in the Apps now Android App and Apple iPhone/Pad App | |
MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd. |
Related Subjects: |Assessing Breathlessness |Fever - Pyrexia of unknown origin
Poor prognosis with old age, severe comorbidities, immunosuppression, bronchial obstruction, and neoplasms.
Cause | Details | Treatment |
---|---|---|
Aspiration of Oropharyngeal Secretions | Most common cause usually in individuals with low GCS (e.g. alcohol, anaesthesia, or neurological disorders) or dysphagia. | Consider clindamycin or a combination of beta-lactam/beta-lactamase inhibitor (e.g., amoxicillin-clavulanate). If the patient is penicillin-allergic, metronidazole plus a respiratory fluoroquinolone may be used. Drainage may be required if the abscess is large or not responding to antibiotics. |
Bacterial Pneumonia | A lung abscess as complication of bacterial pneumonia e.g. Staphylococcus aureus, Klebsiella pneumoniae, or anaerobic bacteria. | Antibiotics targeting by culture or empirical therapy as mentioned above. ABC, oxygen therapy and hydration. In cases of resistant organisms, specific antibiotic regimens will be required. |
Septic Emboli | Septic emboli originating from infective endocarditis or thrombophlebitis can lodge in the pulmonary circulation, leading to abscess formation. | Prolonged antibiotic therapy guided by blood cultures and sensitivity. Anticoagulation may be necessary if the emboli are related to thrombophlebitis. Surgical intervention might be required for persistent infection or if the source of the emboli (e.g., heart valve) needs to be addressed. |
Bronchial Obstruction | Obstruction due to malignancy, foreign body, or stenosis can lead to post-obstructive pneumonia and subsequent abscess formation. | Antibiotic therapy as above, plus addressing the underlying cause of the obstruction (e.g., tumour resection, foreign body removal, or stenting of the airway). Bronchoscopy may be necessary for diagnosis and treatment. |
Immunocompromised States | Patients with compromised immune systems (e.g., HIV/AIDS, cancer chemotherapy, organ transplantation) are at higher risk for lung abscesses due to unusual or opportunistic pathogens, such as Nocardia, fungi, or Mycobacterium tuberculosis. | Broad-spectrum antibiotics or antifungal therapy initially, with subsequent tailoring based on specific organism identification. Immune reconstitution (if possible) and supportive care are crucial. Drainage may be necessary if the abscess does not resolve with medical therapy alone. |
Periodontal Disease | Poor oral hygiene and chronic periodontal disease can lead to aspiration of anaerobic bacteria, resulting in a lung abscess. | Antibiotic therapy that covers anaerobic bacteria, such as clindamycin or amoxicillin-clavulanate. Improving oral hygiene and treating periodontal disease are important preventive measures. |