Clinical practice: treatment of childhood empyema

Abstract

Since the pathogenicity of empyema is a dynamic process, therapeutic strategy must be decided based on empyema stage and clinical experience. Each referral center should agree on a diagnostic and therapeutic flowchart based on current evidence and local expertise. The flow chart outlined for our center is presented.

Impact of antibiotic therapy on laboratory analysis of parapneumonic pleural fluid in children

“…Despite the high prevalence of PPE, especially in developing countries, management of this condition is still controversial [1,2,10,[12][13][14][22][23][24][25]. Pleural fluid analysis is the main tool to guide the need for adjunct surgical treatment and antibiotic therapy in these patients.…”

Management of severe community-acquired pneumonia of children in developing and developed countries

“…Regardless of age, the drainage of pleural fluid is not indicated unless its ultrasonographically-detected volume exceeds 1 cm 86 90. If the volume is higher, drainage is useful to confirm the diagnosis by excluding other causes of pleural effusion, define the quality of the fluid, identify the infecting organism and reduce respiratory symptoms, thus accelerating disease resolution.…”

“…Fibrinolytic medication is advocated when the pleural fluid becomes organised 86 90 93 94. However, the efficacy of fibrinolytic agents is debated and the most recent data seem to suggest that they do not significantly reduce the duration of fever, chest tube drainage or hospitalisation, and that surgery may still be necessary regardless of the stage of the disease 95…”

Pleural empyema due to group A beta-hemolytic streptococci in a newborn: case report

“…If there is fibrin deposition and peel formation, fibrinolysis with urokinase can shorten the hospital stay (6). In the presented case, as chest tube drainage and antibiotic therapy we did perform fibrinolysis or surgical intervention.…”