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