Multiple drugs

Abstract

Lack of efficacy: case report A 48-year-old man exhibited lack of efficacy during treatment with amoxicillin/clavulanic acid, metronidazole, ofloxacin and piperacillin/tazobactam for lung infection and abscess [dosages and routes not stated]. The man admitted for a lung sepsis. Upon admission, a chest CT scan revealed consolidation without cavitation of the upper left lobe suggestive for tuberculosis. He started receiving an unspecified antituberculosis quadritherapy for 1 month without improvement. Therefore, a new CT scan was performed, which showed an aspect of lung abscess. He started receiving empiric antibiotic treatment with amoxicillin/clavulanic acid for 6 weeks; however, no clinical or biological improvement was noted. Six weeks later, the abscess was drained under CT scan. Thereafter, a direct examination revealed gram-negative bacilli and grampositive cocci, but cultures showed only the presence of Prevotella baroniae. Based on these findings, he started receiving piperacillin/tazobactam for 2 weeks and metronidazole and ofloxacin for 4 weeks. At 6 months, it was observed that the abscess increased with an extension in the previous drainage site. Thus, amoxicillin/clavulanic acid was restarted and he received for 6 weeks, but the therapy was unsuccessful. The failure of medical line and percutaneous approach required a surgical control of infection. Therefore, the man underwent a left upper lobectomy. The muddy liquid found in the abscess revealed the presence of Abiotrophia defective in culture. On day 7 of lobectomy, he developed a purulent pericarditis with tamponade and elevation of inflammatory markers. Thus, surgical drainage of pericarditis was done. On day 8 of lobectomy, a CT scan showed concomitant consolidation of right upper lobe suggestive for pneumonia. Subsequently, he started receiving antibiotic therapy with imipenem, vancomycin and clindamycin for A. defective, with favourable response. Histopathological examination of lobectomy showed only non-specific injury. At 4 years of follow-up, he was doing well without recurrence.