treatment

How to Treat Empyema?


Things to note:
  • Aspire and analyze all pleural discharges.
  • Biochemical analysis, fluid microscopy and culture should distinguish a parapneumonic effusion from an empyema.
  • The primary management of empyemas is early and complete drainage to prevent long- term complications by inserting an intercostal drain.

Medical Treatment:
Antimicrobial therapy
If a pneumonia complication, antimicrobial therapy as above.
If not a pneumonia complication:
  • Ampicillin, IV, 1 g 6 hourly.
PLUS
  • Metronidazole, IV, 8 hour for 500 mg.
Follow with:
  • Amoxicillin / clavulanic acid, oral, 875/125 mg 12 hourly.
Duration of treatment until drainage is complete.
Penetration of injury to the chest wall
  • Cloxacillin, IV, 2 g 6 hours.

When to refer:
  • Loculated empyema or inadequate drainage.
  • Pleural thickening and restrictive lung disease chronic empyema requiring surgical decoration.

treatment