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.
