Modification and duration of therapy for empyema complicating an indwelling pleural catheter in adults

For adults with empyema complicating an indwelling pleural catheter, modify antibiotic therapy based on the results of microbiological investigations.

If a pathogen is not identified, seek expert advice for antimicrobial choice.

Once the patient has improved and the pleural space is adequately drained (which typically occurs after intrapleural enzyme therapy), switch to oral therapy. For guidance on when to switch to oral therapy, see Guidance for intravenous to oral switch.

The total duration of therapy (intravenous + oral) is usually 2 to 4 weeks.

The indwelling pleural catheter is often able to be salvaged and usually only requires removal in patients with uncontrolled infection. Signs of uncontrolled infection (despite effective drainage and antimicrobials) include persistent signs of systemic infection and ongoing fever.

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