Infectious Diseases

	Answer 1 Clindamycin. This patient has aspirated and developed a lung abscess. Risk factors for aspiration include periodontal disease, alcoholism, and seizure disorder. Patients with an anaerobic lung abscess present with an indolent clinical course of low-grade fever, productive cough with foul-smelling sputum, anorexia, and weight loss that evolves over a period of weeks to months. Anaerobes are recovered in up to 89% of patients with lung abscesses, with the most common being Peptostreptococcus, Bacteroides, and Fusobacterium species and microaerophilic Streptococcus species.1 Standard treatment for an anaerobic lung abscess is a prolonged course of clindamycin (4–6 wk or until resolution of the lung abscess or stabilization of the abscess into a small lesion).1 Although penicillin is effective against most oropharyngeal anaerobes, it is ineffective against ß-lactamase–producing anaerobes such as Fusobacterium and Bacteroides.2 Most patients with primary lung abscess improve with antibiotics, with cure rates of 90% to 95%.3 Surgical drainage of the lung abscess is indicated when antibiotic therapy has failed. REFERENCE 1. Bartlett JG, Gorbach SL, Tally FP, Finegold SM. Bacteriology and treatment of primary lung abscess. Am Rev Respir Dis 1974;109:510–8. 2. Appelbaum PC, Spangler SK, Jacobs MR. Beta-lactamase production and susceptibilities to amoxicillin, amoxicillin-clavulanate, ticarcillin, ticarcillin-clavulanate, cefoxitin, imipenem, and metronidazole of 320 non-Bacteroides fragilis Bacteroides isolates and 129 fusobacteria from 28 U.S. centers. Antimicrob Agents Chemother 1990;34:1546–50. 3. Bartlett JG. HIV infection and surgeons. Curr Probl Surg 1992;29:197–280. Click here to return to the questions
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