Modification and duration of therapy for empyema complicating thoracic trauma or haemothorax

For empyema complicating thoracic trauma or haemothorax in adults and children, modify antibiotic therapy based on the results of microbiological investigations, noting that these infections are typically polymicrobial.

Once the patient has improved and, if drainage is feasible, the pleural space is adequately drained, switch to oral therapy. For guidance on when to switch to oral therapy, see Guidance for intravenous to oral switch. If a pathogen is not identified, seek expert advice for antimicrobial choice.

The total duration of therapy (intravenous + oral) is usually 2 to 4 weeks – seek expert advice because there are few data to inform the optimal duration.

Consider monitoring serum C-reactive protein (CRP) or residual fluid volume on thoracic ultrasound for response to treatment.