Effects of Prolonged Antibiotic Therapy in Lung Abscesses-Analysis of Case Series

Abstract

The incidence and mortality rate of lung abscess cases have declined significantly following the widespread introduction of broad-spectrum antibiotic therapy. Administration of antibiotics is considered the main treatment option, replacing invasive management, which currently is reserved only for selected patients. Four cases of patients with large lung abscesses analyzed in the article demonstrate the effectiveness of prolonged antibiotic therapy in the form of clinical improvement and regression of lesions imaged with computed tomography (CT) scans, in the absence of surgical drainage. However, the lack of a comparator group undergoing surgical interventions limits the ability to generalize the findings. The article highlights multiple diagnostic and management challenges clinicians face when treating complicated lung abscesses; however, the presented evidence is limited by a small sample size and lack of controls. Although the incidence of lung abscesses has dropped, they are still frequently seen in pulmonology, surgery, pediatrics, and internal medicine departments. In the face of the worldwide antimicrobial resistance crisis, the choice of effective antibiotic therapy remains a challenge, and there is no consensus on the duration of the treatment, as well as specific timing for introducing surgical intervention. As there are no high-quality recommendations or international studies evaluating the epidemiology of lung abscesses in the 21st century, further research seems necessary to help clinicians make appropriate therapeutic decisions.

Keywords: CT lesions; antibiotic therapy; lung abscess; lung infection; necrotic; pneumonia; resistance.

Figure 1

(a) Chest x-rays and (b) CT scans performed on the day of the patient's admission to the hospital (1st of February 2024)—Case 1. (b) The abscess wall is marked with an arrow.

Figure 2

Follow-up CT scans of the patient's chest (Case 1) performed on the (a) 20th of February 2024 and (b) 27th of March 2024.

Figure 3

(a) Patient's chest x-ray performed on admission on the 13th of August 2022. (b) CT scans of the chest taken on the 17th of August 2022—Case 2.

Figure 4

Follow-up CT scans performed on the (a) 1st of September 2022, (b) 6th of October 2022, (c) 25th of October 2022, and (d) 28th of December 2022—Case 2.

Figure 5

Follow-up CT scans performed on the (a) 7th of June 2023 and (b) 21st of February 2024—Case 2.

Figure 6

(a) CT scans performed on admission on the 14th of March 2024. Follow-up CT scans performed on the (b) 5th of April 2024 and (c) 29th of May 2024—Case 3. (b, c) The abscess is marked with an arrow.

Figure 7

(a) A chest x-ray performed on admission on the 4th of October 2022. CT scans performed on the (b) 7th of October 2022 and (c) 22nd of November 2022—Case 4.

Figure 8

Treatment duration in Patients (a) 1, (b) 2, (c) 3, and (d) 4.