Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
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The Antibiotic Cornerstone
The primary treatment for a lung abscess is medical, not surgical. The advent of potent antibiotics has transformed this from a surgical disease with high mortality to a medical one with high cure rates. The principles of treatment are prolonged duration, broad anaerobic coverage, and ensuring adequate drainage via the bronchial tree.
Duration of Therapy: This is the most critical factor in successful management. Antibiotics must be continued until the cavity is resolved or stabilized on X-ray, which typically takes 4 to 8 weeks, and sometimes months. Short courses of treatment lead to high relapse rates. Treatment usually starts intravenously and is switched to oral medication once the patient is febrile and clinically stable.
Unlike abscesses elsewhere in the body, where the rule is “pus must be let out” via surgery, lung abscesses often drain naturally through the bronchial tree, aided by coughing and postural drainage.
Surgery is now rare, required in less than 10 percent of cases, but remains a lifesaving option for complications or failure of medical therapy.
Indications for Surgery:
Procedures:
Response to therapy is monitored both clinically and radiologically.
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Lung abscesses have thick, fibrous walls that antibiotics have trouble penetrating; it takes a long time to kill all the bacteria in the center of the cavity and for the lung tissue to heal completely.
Usually, the lung drains itself naturally by coughing up the pus. Needles are risky because they can puncture the lung or spread infection to the chest cavity, so they are only used if natural drainage fails.
Sometimes, a thin walled air sac called a pneumatocele remains permanently. As long as the infection is gone and it is not causing symptoms, this is considered a healed state and doesn’t require surgery.
Lung surgery, such as lobectomy, is a significant operation with risks, but in cases where the abscess is causing massive bleeding or will not heal, it can be lifesaving. We reserve it for when antibiotics fail.
The first sign is that your fever breaks and you feel better, hungrier. The cough and X-ray findings take much longer to improve, so we rely on your assessment to judge early success.
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