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TREATMENT SUGGESTIONS FROM THE LITERATURE

Initial treatment of lung abscess is conservative medical management.
Duration of uncomplicated cases 2-3 weeks of antibiotics intravenously and then a further course of oral antibiotics for 4-8 weeks. Coverage should be directed against staph. a and anaerobes at the minimum.
Intervention ( percutanous aspirate) may be required if patients is seriously ill or does not improve by 7-10 days
Surgical intervention should be reserved for refractory cases, sudden and dramatic decline in the clinical status. Tan et al ped inf dis 95
Lobectomy is rare and should be reserved for failure of appropriate IV antibiotic and surgical drainage. Emanual/Shulman clinical ped 95
Percutaneous catheter drainage of tension pneumatocele secondary to lung abscess or infected pneumatocele can be done safely and effectively in children, early drainage is helpful both as diagnostic and therapeutic procedure as well as assist weaning from mechanical ventilation. Zuhdi et al crit care med 96
In children with pulmonary abscess refractory to conservative medical therapy operative resection can provide significant improvement, formal lobectomy often is required and yield a good outcomes. Cowles et al J ped surg 2002
Early Ultra sound with guided percutaneous aspiration of peripherally located lung abscess soon after admission can be initial procedure of choice in the primary treatment of lung abscess . Wong et al Act ped sin 97
Surgical intervention plays an important role in the treatment of pediatric lung abscess that failed to the medical treatment and simple drainage procedures and can shorten the hospital stay. M.-H. Wu et al ped surg 97
Aggressive pulmonary interventional therapy can be diagnostic and therapeutic in the infected lung abscess, but aggressive pleural intervention can be harmful to a child who developed necrotizing pneumonia. F.A. Hoffer Et al ped Radiol 99

POSSIBLE COMPLICATIONS

– Over expansion of the abscess resulting in compression of the lung
Empyema, pyothorax, pneumothorax n Respiratory failure
Bronchopleural fistula
Distant metastasis
Bronchiectasis
Scoliosis
Restrictive lung disease

PROGNOSIS

– Deaths that still occur are usually attributed to the underling diseases, and are almost unheard of in primary lung abscess.
Excellent if effective therapy and close follow up are provided and the predisposing causes are eliminated.
Normal pulmonary function tests in 9/11pt.with primary lung abscess 9 years after diagnosis. Asher et al 82


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