Treatment of Empyema
The treatment of empyema focuses on removing the infected fluid, eliminating the infection, and restoring lung function. Since empyema can become life-threatening if untreated, early intervention is essential. Treatment varies depending on the stage and severity of the condition.
Antibiotics
Doctors immediately start broad-spectrum intravenous antibiotics to fight the infection. Once lab results identify the specific bacteria, doctors adjust the antibiotics accordingly. In TB-related empyema, doctors prescribe a full course of anti-tuberculosis medication, typically lasting six to nine months.
Common antibiotics used for bacterial empyema include:
Ceftriaxone or piperacillin-tazobactam
Clindamycin or metronidazole (for anaerobic bacteria)
Vancomycin (if MRSA is suspected)
Patients often remain on IV antibiotics for several days, followed by oral antibiotics for 2–4 weeks.
Drainage
Doctors must remove the infected fluid to allow the lung to re-expand. This is done using:
Chest tube insertion (intercostal drain) – Doctors insert a flexible tube into the chest to drain pus. Doctors often use ultrasound to guide the procedure.
Image-guided drainage – In some cases, CT or ultrasound helps place the drain in the best location.
Intrapleural fibrinolytics – Doctors may use medications like alteplase and DNase through the drain to break up thick pus and improve drainage.
Surgery | Treatment of Empyema
If drainage and antibiotics do not improve empyema, doctors may need to perform surgery:
Video-assisted thoracoscopic surgery (VATS) – Minimally invasive; used to break up loculated pus and remove infected tissue
Open thoracotomy – In severe cases, especially with organised empyema and lung entrapment, surgeons perform full chest surgery
Children usually respond well to antibiotics and chest tube drainage. Surgery is less often required in paediatric cases unless there is extensive loculation or no improvement.
In South Africa, treatment access may vary. Urban hospitals typically offer surgical options and intensive care, while rural clinics may rely on antibiotics and basic drainage. Outreach programmes and hospital referrals help ensure continuity of care.
The treatment of empyema requires a team effort—combining infection control, fluid removal, and lung rehabilitation. When addressed early, most patients recover well without long-term issues.
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