Antibiotic instillation for a chronic lung abscess

INTRODUCTION: Antibiotic treatment of lung abscesses fails in 10–20% of cases and require surgery, however, some are unsuitable for resection. Alternative options carry significant morbidity. CASE REPORT: A 47 year old man with inoperable non-small cell lung cancer developed a lung abscess following definitive radiotherapy. Initial antibiotic therapy was successful, however four years later his symptoms recurred. Despite multiple courses his symptoms recurred despite long-term antibiotics. Immediately following a diagnostic aspiration, ceftriaxone and metronidazole were instilled into the abscess with subsequent clinical and radiological resolution. DISCUSSION: Lung abscesses are an uncommon complication of radiotherapy. Antibiotic therapy can fail for a number of reasons. Although instillation of antibiotics has not been described in the management of lung abscesses, the direct application of antifungals for aspergillomas is well documented and case series report success in other abscess sites. CONCLUSION: Direct antibiotic instillation following lung abscess aspiration adds minimal risk and is potentially curative.