Changing Trends in the Treatment of Lung Abscess

1) Antibiotics have improved the prognosis, and have reduced the incidence and morbidity of lung abscess, but have by no means eradicated the disease. They have often delayed diagnosis and treatment. 2) Lung abscess is a surgical problem from the outset, and demands close cooperation between the internist and the surgeon. 3) Carcinoma as an etiological factor in lung abscess is increasingly common, and should invariably be considered in the diagnosis. 4) The use of antibiotics has greatly increased the efficacy of conservative therapy in the early abscess. 5) Bronchoscopy should be performed in every case of pulmonary abscess, both for diagnosis and as an integral part of conservative treatment. 6) Drainage therapy, once the surgical treatment of choice, is now largely reserved for the progressive acute abscess in the poor risk patient, and in the good risk patient where a good result can be accurately anticipated. Antibiotics have, however, improved the overall good results in drainage, and the procedure should by no means be discarded. 7) Resection therapy is the definitive surgical procedure in most abscesses, particularly since antimicrobial agents have come into use. Mortality is gratifyingly low, and results excellent. It would seem to be the answer to the problem of the chronic abscess. 8) When resection therapy is used, segmental resection or lobectomy are preferable to pneumonectomy, if at all feasible, because of the lower mortality and complications, and in order to preserve maximum function. 9) Simple excision as a technique of segmental resection in chronic lung abscess appears at this time to offer great hope for effective conservation of lung tissue. 10) Although surgical therapy produces better results than conservative, the regimens are complimentary rather than competitive. 11) Intermuscular, oral, and aerosol antibiotics, notably penicillin, have materially improved the prognosis in resection. The incidence of empyema, however, is far too high, and should be improved.