title: Treatment of pleural empyema secondary to pneumonia: thoracocentesis regimen versus tube drainage.
abstract: BACKGROUND
  Pleural empyema is a well known complication of pneumonia. Attitudes differ, however, about the best treatment of this condition and the place of drainage, early operation, and local antibiotics.
  
  
  METHODS
  In a retrospective study 94 consecutive patients with verified empyema caused by pneumonia were admitted to the department of either pulmonary medicine or thoracic surgery. Treatment was either by a lavage regimen (daily thoracocentesis, saline rinse, systemic antibiotics, and in some patients instillation of local antibiotics) in the medical ward (51 patients) or by tube drainage and systemic antibiotics in the surgical unit (43 patients).
  
  
  RESULTS
  The stay in hospital was significantly shorter in the medically treated patients than in the surgical group--2.3 v 5.0 weeks respectively. Furthermore, pleurocutaneous and bronchopleural fistulas developed more frequently in patients treated by tube drainage than in those treated with the thoracocentesis regimen alone (13 (30%) v 5 (10%) and 6 (14%) v 2 (4%) for each complication respectively). The overall mortality was 8.5% with no differences between treatments.
  
  
  CONCLUSIONS
  Treatment with a lavage regimen plus local and systemic antibiotics seems to be associated with a lower frequency of complications and a shorter duration of hospital stay than tube drainage and systemic antibiotics. These results should be confirmed by a prospective, randomised study.
authors: Department of Pulmonary Medicine, Bispebjerg Hospital, Copenhagen, Denmark.
authors: H K
authors: HK
authors: Storm
authors: M
authors: M
authors: Krasnik
authors: K
authors: K
authors: Bang
authors: N
authors: N
authors: Frimodt-Møller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D016724:Empyema, Pleural / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications* / Q000382:microbiology; D012189:Retrospective Studies; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome