Empyema/Parapneumonic Effusion
Follow Up

Follow Up

Antimicrobial Stewardship

  • Complicated parapneumonic effusions & empyema typically require 4-6 weeks of therapy
  • Uncomplicated parapneumonic effusions typically resolve with appropriate treatment of underlying pneumonia
  • Ideally collection should be resolved before pulling the drain with guidance from respirology; consider repeat imaging
  • Duration is influenced by all of: the organism, adequacy of source control, and clinical response
  • When possible, narrow antibiotic therapy based on culture results
  • Empiric anaerobic coverage may not need to be continued when a specific organism is isolated (e.g., S.pneumoniae or S.aureus)
  • Once adequate source control and clinical improvement have been achieved IV to PO can be considered
  • Amoxicillin-clavulanate is a reasonable stepdown from ceftriaxone + metronidazole
  • For alternative oral stepdown options consult with ID or ASP/ID Pharmacist
  • Generally antibiotics such as metronidazole and fluoroquinolones have excellent oral bioavailability and can be given orally for the entire course unless contraindicated