Question
A 34-years old male patient presented with complaints of dyspnea and productive cough with postural variation. The patient gives a history of 20 pack years of smoking. The patient also has a history of recent binge drinking. A chest X-ray was taken and is shown below. What is the next step in management?
A. Gemcitabine and carboplatin-based chemotherapy
B. Lobectomy
C. Intravenous clindamycin and fluids
D. Antitubercular therapy
Show Answer
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Correct Answer » C
Explanation
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Ans: C. Intravenous clindamycin and fluids
(Ref Harrison 19/e p814-815, 18/e p2145-2146)
- Case is suggestive of lung abscess.
Lung abscess:
- Most common cause of primary lung abscess – Anaerobes.
- Next step in management – Intravenous clindamycin & fluids.
Primary lung abscesses:
- Due to anaerobic bacteria (as well as microaerophilic streptococci) in gingival crevices aspirated into lung parenchyma in susceptible host.
- Carrier with burden of aspirated material unable to clear bacterial load.
Clincial features:
- Pneumonitis – Initially.
- Exacerbated by tissue damage due to gastric acid.
Recommended regimens:
Initial therapy:
- Clindamycin (600 mg IV three times daily).
After fever disappearance & clinical improvement:
- Clindamycin (300 mg PO four times daily).
- IV-administered beta-lactam/beta- lactamase combination.
On stable condition:
- Switched to oral amoxicillin-clavulanate.
- Continued until imaging demonstrates cleared lung abscess / regressed small scar.
- Treatment duration: 3-4 weeks upto 14 weeks.
