The treatment of lung abscess, these three methods are the most effective!

Lung abscess develops very quickly, causing patients to experience many adverse reactions such as difficulty breathing within a short period of time. In this case, antibacterial drug treatment, pus drainage, and surgical treatment are the three best methods to treat this disease.

1. Antimicrobial therapy

Aspiration lung abscesses are mostly caused by anaerobic infections, which are generally sensitive to penicillin. Only Bacteroides fragilis is not sensitive to penicillin, but is sensitive to lincomycin, clindamycin and metronidazole. The dose of penicillin can be determined according to the severity of the disease. For mild cases, 1.2 million to 2.4 million U/d can be used. For severe cases, 10 million U/d can be given by intravenous drip in divided doses to increase the drug concentration in the necrotic tissue. The body temperature generally returns to normal within 3-10 days of treatment, and then the drug can be switched to intramuscular injection. If penicillin is not effective, lincomycin 1.8-3.0g/d can be used by intravenous drip in divided doses, or clindamycin 0.6-1.8g/d, or metronidazole 0.4g can be used orally or intravenously 3 times a day.

Hematogenous lung abscesses are mostly caused by staphylococcal and streptococcal infections, and β-lactamase-resistant penicillin or cephalosporin can be used. If the bacteria are methicillin-resistant Staphylococci, vancomycin, teicoplanin or linezolid should be used.

If the infection is caused by amoeba, treat it with metronidazole. If it is a Gram-negative bacillus, the second or third generation cephalosporin, fluoroquinolone (such as moxifloxacin) can be used, and aminoglycoside antibiotics can be used in combination.

The course of antimicrobial therapy is 8-12 weeks, until the abscess cavity and inflammation disappear on the chest X-ray, or only a small amount of residual fibrosis is found.

2. Drainage of pus

Effective measures to improve efficacy. For those with thick sputum that is difficult to cough up, expectorants or nebulized saline, expectorants or bronchodilators can be used to facilitate sputum drainage. Those who are in good physical condition can use postural drainage to remove sputum. The drainage position should put the abscess in the highest position, 2-3 times a day, each time for 1-15 minutes. Flushing and suction through fiberbronchoscope are also effective methods of drainage.

3. Surgical treatment

Indications: ① Lung abscess lasts for more than 3 months, the abscess cavity does not shrink after medical treatment, or the abscess cavity is too large (more than 5 cm) and is estimated to be difficult to close. ② Severe hemoptysis is not responsive to medical treatment or is life-threatening. ③ Patients with bronchopleural fistula or empyema who are not effectively treated with aspiration, drainage and flushing. ④ Bronchial obstruction limits airway drainage, such as lung cancer. For patients with severe conditions who cannot tolerate surgery, a catheter can be inserted through the chest wall into the abscess cavity for drainage. The patient's general condition and lung function should be evaluated before surgery.