Pleural empyema medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

Definitive treatment for empyema entails drainage of the infected pleural fluid. A chest tube may be inserted, often using ultrasound guidance. Intravenous antibiotics are given. If this is insufficient, surgical debridement of the pleural space may be required.

Antibiotic Therapy

Following are the guidelines to treat Pleural empyema .

▸ Click on the following categories to expand treatment regimens.

Pleural Empyema   ▸   Neonates   ▸   Infants/Children   ▸   Adult   ▸   Subdural

Neonates Preferred Regimen Age 0-7 days and Weight ≤ 2000 gm ▸ If MSSA ▸ Nafcillin 25 mg/kg IV q12h OR Oxacillin 25 mg/kg IV q12h ▸ If MRSA ▸ Vancomycin 12.5 mg/kg IV q12h Age 7-28 days and Weight ≤ 2000 gm ▸ If MSSA ▸ Nafcillin 25 mg/kg q8h OR Oxacillin 25 mg/kg IV q12h ▸ If MRSA ▸ Vancomycin 15 mg/kg IV q12h Age 0-7 days and Weight > 2000 gm ▸ If MSSA ▸ Nafcillin 25 mg/kg q8h OR Oxacillin 25 mg/kg IV q12h ▸ If MRSA ▸ Vancomycin 18 mg/kg IV q12h Age 7-28 days and Weight > 2000 gm ▸ If MSSA ▸ Nafcillin37 mg/kg q6h OR 'Oxacillin 37 mg/kg q6h ▸ If MRSA ▸ Vancomycin 22 mg/kg q12h

Infants/Children Preferred Regimen ▸Cefotaxime 100 mg/kg IV q8h OR Ceftriaxone 100 mg/kg IV q24h 'If MSSA ▸ Vancomycin 40 mg/kg/day IV in 3-4 divided doses With or Without 'Cefotaxime 100 mg/kg IV q8h OR Ceftriaxone 100 mg/kg IV q24h If H.Influenzae suspected

Adult Preferred Regimen Strep. pneumoniae or Streptococcus sp (Group A) ▸Cefotaxime 2 gm IV q8h OR ▸Ceftriaxone 2 gm IV q24h or Penicillin 12-18 million units IV divided q4h/day OR ▸Ampicillin 8-12 gm IV divided q4h/day Staph. aureus ▸MSSA Nafcillin2 gm IV q4h OR Oxacillin 2 gm IV q4h ▸MRSA Vancomycin 10-15 mg/kg IV q8-12h OR Linezolid 600 mg IV q12h H. influenzae ▸Ceftriaxone 2 gm IV q24h Subacute/Chronic ▸Clindamycin 450-900 mg IV q8h PLUS 'Ceftriaxone 2 gm IV q24h

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Adult Preferred Regimen Strep. pneumoniae or Streptococcus sp (Group A) ▸Cefotaxime 2 gm IV q8h OR ▸Ceftriaxone 2 gm IV q24h or Penicillin 12-18 million units IV divided q4h/day OR ▸Ampicillin 8-12 gm IV divided q4h/day Staph. aureus ▸MSSA Nafcillin2 gm IV q4h OR Oxacillin 2 gm IV q4h ▸MRSA Vancomycin 10-15 mg/kg IV q8-12h OR Linezolid 600 mg IV q12h H. influenzae ▸Ceftriaxone 2 gm IV q24h Subacute/Chronic ▸Clindamycin 450-900 mg IV q8h PLUS 'Ceftriaxone 2 gm IV q24h Alternative Regimens Strep. pneumoniae or Streptococcus sp (Group A) ▸Vancomycin 1 gm IV q12h H. influenzae ▸TMP-SMX (5-10 mg/kg/day as trimethoprim component) IV/po in 2-3 divided doses OR Ampicillin-Sulbactam 3 gm IV q6h (child dose 100-300 mg/kg/day IV divided q6h) Chronic ▸Cefoxitin 2 gm IV q6-8h OR Imipenem 0.5 gm IV q6h OR Piperacillin-Tazobactam 3.375 gm IV q6h (or 4-hour infusion of 3.375 gm q8h) OR Ampicillin-Sulbactam 3 gm IV q6h

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