Lung Abscess
Description Diagnostic criteria General and supportive measures Medicine treatment Surgical treatment Referral ICD-10 code: J85 DESCRIPTION A suppurative process that results from destruction of the pulmonary parenchyma and formation of a cavity. The cavity may be single, e.g. after aspiration or multiple, e.g. staphylococcal disease and cystic fibrosis. Lung abscess may follow pneumonia ca
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Surgical treatment
Referral
ICD-10 code: J85
DESCRIPTION
A suppurative process that results from destruction of the pulmonary parenchyma and formation of a cavity. The cavity may be single, e.g. after aspiration or multiple, e.g. staphylococcal disease and cystic fibrosis.
Lung abscess may follow pneumonia caused by:
- S. aureus,
- K. pneumoniae,
- anaerobic organisms,
- S. pneumoniae,
- H. influenza,
- M. tuberculosis.
Metastatic lung abscesses due to septicaemia or septic emboli may also occur.
Complications include:
- bronchiectasis,
- rupture into the bronchial tree or pleural cavity or vessels,
- bronchopleural fistula.
- empyema,
- pulmonary osteo-arthropathy,
- brain abscess,
DIAGNOSTIC CRITERIA
- Intermittent or recurrent fever, malaise, weight loss, anorexia and productive, purulent cough with halitosis and haemoptysis.
- Clubbing and amphoric breathing over the cavity may be present.
- Chest X-ray will confirm cavity/cavities with or without an air-fluid level.
GENERAL AND SUPPORTIVE MEASURES
- Identify the underlying cause and exclude inhalation of a foreign body.
- Physiotherapy and postural drainage.
- Correct anaemia.
- Nutritional support.
MEDICINE TREATMENT
Empiric antibiotic therapy for at least 14 days.
- Amoxicillin/clavulanate, IV, 25 mg/kg/dose of amoxicillin component 8 hourly (do not exceed 10 mg/kg/day of clavulanate component).
Change antibiotics according to culture and sensitivity results.
If there is a poor response and no culture to guide antibiotic choice: consider local surveillance of pathogens and change accordingly.
If there is evidence of good clinical response, change to:
- Amoxicillin/clavulanic acid, oral, 45 mg/kg/dose of amoxicillin component 12 hourly.
SURGICAL TREATMENT
Consider surgical drainage of abscess and/or resection if medical treatment fails.
REFERRAL
- Complicated lung abscess not responding to therapy.
- Lung abscess where the underlying cause has not been established.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 15: Respiratory System, 15.3 Chronic Lung Infections, 15.3.2 Lung Abscess