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Management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

accurate assessment of the size of the effusion and, where necessary, loculations using ultrasound or CT scanning
early diagnostic pleural aspiration, to assess fluid appearance, bacteriology and biochemistry
antibiotic therapy - depends on the bacteriology of the aspirated fluid; often requires metronidazole because organisms may not be revealed by culture
pleural fluid is drained - if this is not possible then surgery is indicated (surgical evacuation and lung decortication so that it may be fully expanded and so obliterate the pleural space)
intrapleural fibrinolytic therapy - a systematic review stated " with complicated infective pleural effusion or empyema, intrapleural fibrinolytic therapy was associated with a reduction in the requirement for surgical intervention and overall treatment failure but with no evidence of change in mortality" (2)
consider the possibility of tuberculosis

Reference:

Drug and Therapeutics Bulletin 2006; 44 (3): 17-20.
Altmann ES et al. Intra-pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema. Cochrane Systematic Review October 2019

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