Table 1:

Microbiology, empiric antibiotic therapy and surgical therapy of empyema in children

Bacterial causes of empyema68Empiric antibiotic therapy3,5,9Surgical therapy*25
  • Streptococcus pneumoniae

  • Staphylococcus aureus

  • Group A Streptococcus

  • Third-generation cephalosporin (intravenous)

  • Chest tube drainage, and/or fibrinolytics and/or video-assisted thoracic surgery

  • Methicillin-resistant S. aureus (in some geographic regions)

  • Third-generation cephalosporin (intravenous) plus vancomycin or clindamycin

  • Anaerobic bacteria (mostly in children with impaired airway defenses)

  • Third-generation cephalosporin (intravenous) plus clindamycin

  • * Need for and choice of surgical therapy should take into account the patient’s clinical status, radiographic findings, local surgical expertise and patient and parent preferences. See text for details.