12.7 Para-pneumonic pleural effusion/empyema
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Para-pneumonic effusion or empyema | Ceftriaxone 2g OD IV Or Inj Amoxicillin- clavulanate 1.2g IV TDS Duration: 4 weeks | Piperacillin-tazobactam 4.5g IV q6h Duration: 4 weeks | Add MRSA agent: Vancomycin or Teicoplanin or Linezolid (use only if TB is excluded) if suspected as per comments in pneumonia section. Pleural fluid needs to be sent for microbiological analysis and/or direct inoculation in automated blood- culture bottles for better diagnostic yield. Change to targeted therapy based on pleural fluid cultures. Antibiotics to continue for 4 weeks. Pleural drain or ICD may be needed if pleural effusion is persistent. Surgical intervention in empyema is usually by video-assisted thoracotomy (VATS). When the evacuation of the cavity or lung expansion is not achieved with VATS, an open-thoracotomy is indicated. |
For common etiological agents of Para-pneumonic pleural effusion/empyema, see Annexure B.12.7
References
1. Sharma BB, Singh V. Indian pneumonia guidelines. Lung India. 2012;29(4):307-308. doi:10.4103/0970-2113.102793
2. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community- acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. doi:10.1164/rccm.201908-1581ST
3. Treatment Guidelines for Antimicrobial Use in Common Syndromes. 2nd edition. ICMR. 2019. New Delhi (Accessed on 2nd April, 2025). Available from: https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-
guidelines/Treatment_Guidelines_2019_Final.pdf