Management of Complicated Para-pneumonic Effusion and Pleural Empyema with Initial Parenteral Antibiotics and Early Switch to Oral Equivalent
Intravenous (IV) antibiotics had been the mainstay of therapy for children with complicated para-pneumonic effusion (PPE) and pleural empyema (PE). Whereas oral antibiotics have been used to complete a prescribed course of therapy, when to switch and how long to treat are more a matter of style than a matter of evidence or official guidelines. There is also controversy regarding the use of video-assisted thoracoscopic surgery (VATS) versus chest tube insertion with fibrinolysis when drainage is indicated. Substantial practice variation exists.
Retrospective chart review and descriptive analysis of children managed by the pediatric infectious diseases service at Kosair Children Hospital between 2008 and 2012.
A total of 59 children met inclusion criteria. All patients received IV antibiotics at admission. Sixty-seven percent of children had a surgical procedure on the day of admission or the following day; all of these were VATS, except for 2 children who had a chest tube placed and later underwent VATS. The mean time to VATS was 1.4 days [95% CI 1.08, 1.80]. In 70% of the cases that underwent drainage, no organism was identified by culture of the pleural fluid. All patients received IV antibiotics at admission and all were discharged on oral antibiotics; the mean time to switch was 7.9 days [95% CI 6.76, 9.12] and the mean duration of oral antibiotic therapy was 16.98 days [15.3, 18.64]. There were no deaths; 6 patients required repeat surgical intervention, but this was not related to use of oral antibiotic therapy.
Children with complicated PPE and PE can be managed effectively with early VATS and early switch from IV to oral antibiotic therapy.
C. Espinosa, None