MedBalans

Pleural empyema

Adults · verify locally

Inpatient

First line

  • Ampicillin/sulbactam · i.v.

    3 g IV q6h

Alternatives

  • Ceftriaxone + metronidazole · i.v.

    Ceftriaxone 1–2 g IV daily + metro 500 mg IV tid

  • Piperacillin/tazobactam ± vancomycin · i.v.

    Pip/tazo 4.5 g IV q6–8h; add vancomycin if MRSA / nosocomial risk

Duration

2–6 weeks after adequate drainage (individualize)

Notes

  • Source control (drainage ± surgery) is mandatory.
  • Do not rely on antibiotics alone for established empyema.

Culture pleural fluid (± blood) before antibiotics.

  • • BTS pleural disease / IDSA guidance (community) (2023)