Lung abscess: the non-conservative management: a narrative review

Background and Objective: Systemic antibiotics are the best treatment options for lung abscesses. However, up to 37% of lung abscesses do not respond to antibiotics and may require additional interventions. Percutaneous transthoracic tube drainage (PTTD), endoscopic catheter drainage (ECD) and surgical resection are additional options available when first line therapy with systemic antibiotics are unsuccessful. In this narrative review, we summarize all available interventional procedures, techniques, complications, safety, and contraindications. Methods: A literature search was performed using Medline/PubMed from January 1980 to October 2023. “lung abscess”, “pulmonary abscess”, “endoscopic drainage”, “percutaneous drainage”, “tube drainage”. Pediatric patients were excluded from this study. Key Content and Findings: PTTD and ECD are fairly safe procedures. Performing PTTD or ECD without delay may shorten the duration of hospital stay. This may lower the burden on health care. Moreover, draining abscesses may relieve discomfort in the clinical symptoms associated with abscesses. The primary factor in choosing ECD over PTTD is the location of the abscess, and the presence of a bronchial airway leading to the abscess for successful ECD. ECD has lower rate of complications and mortality; and similar success rate compared to PTTD. While mortality has been reported with PTTD, ECD appears to be safer according to present data. Conclusions: PTTD and ECD are safe procedures, with low complication rates. ECD has a lower complication rate than PTTD does.