GuidelinesOther guideline
Empyema
Infection Empyema Brief outline/clinical setting This is a complication of a parapneumonic effusion which occurs when bacteria invade the pleural space. Any pleural fluid requires evaluation to exclude an empyema Diagnosis: Exudative effusion with pus and a positive gram stain. Culture mandatory but may be negative pH<7.2 necessitates urgent drainage Aetiologies/organisms Pneumococcal, Gram ne
| Infection | Empyema |
| Brief outline/clinical setting | This is a complication of a parapneumonic effusion which occurs when bacteria invade the pleural space. Any pleural fluid requires evaluation to exclude an empyema Diagnosis: Exudative effusion with pus and a positive gram stain. Culture mandatory but may be negative pH<7.2 necessitates urgent drainage |
| Aetiologies/organisms | Pneumococcal, Gram negatives Klebsiella or other Enterobacterales, Strep anginosis, very rarely other gram negatives esp. if hospital acquired ( A.baumannii, species, Pseudomonas aeroginosa, Stenotrophomonas maltophilia), Haemophilus Influenza |
| Optimal antimicrobial selection | Amoxicillin- clavulanate 1.2g IVI 8hrly |
| Duration | 5 – 7 days |
| Alternative if allergic/not available | Ceftriaxone 1g IV daily + metronidazole 400mg 8hrly |
| Comments | Fluid Drainage is the mainstay of treatment |
| Level of evidence |