From the Guidelines
Pleurisy treatment should prioritize addressing the underlying cause, with antibiotics prescribed for bacterial infections, and supportive care for viral causes, alongside pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) and potential thoracentesis for significant pleural effusion. The treatment approach may vary depending on the severity of the condition and the patient's overall health.
Key Considerations
- For bacterial infections, antibiotics should be chosen based on the specific pathogen, with considerations for community-acquired or hospital-acquired infections 1.
- In cases where bacterial culture results are not available, antibiotics should cover community-acquired bacterial pathogens and anaerobic organisms, with hospital-acquired empyema requiring broader spectrum antibiotic cover 1.
- The use of small bore chest tubes (14F or smaller) is recommended for initial drainage of pleural infection 1.
- Surgical intervention may be necessary for patients who fail to improve with medical therapy, with different surgical approaches available, including endoscopic techniques (VATS) and open techniques (thoracotomy) 1.
Treatment Approach
- Start with NSAIDs like ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg twice daily) to reduce inflammation and pain.
- For more severe pain, codeine or other opioid medications may be prescribed.
- Rest and limiting activities that worsen pain are essential during recovery.
- Thoracentesis may be necessary to drain fluid and relieve symptoms in cases with significant pleural effusion.
- Deep breathing exercises, although initially painful, can prevent lung complications.
- Apply heat or cold packs to the painful area for additional relief.
Surgical Intervention
- Surgical intervention is considered when medical therapy fails, with the choice of surgical approach depending on the individual patient's condition.
- Different surgical methods, including drainage, debridement, and visceral decortication, can be deployed, with the best approach determined on a case-by-case basis 1.
From the Research
Pleurisy Treatment Overview
- Pleurisy treatment typically consists of pain management with nonsteroidal anti-inflammatory drugs, as well as specific treatments targeted at the underlying cause 2
- The diagnosis of pleurisy can be made after excluding other significant causes of pleuritic pain, such as pulmonary embolism, pericarditis, pneumonia, myocardial infarction, and pneumothorax 2
Diagnostic Approach
- History, physical examination, and chest radiography are recommended for all patients with pleuritic chest pain 2
- Electrocardiography is helpful, especially if there is clinical suspicion of myocardial infarction, pulmonary embolism, or pericarditis 2
- Thoracocentesis should be performed for new and unexplained pleural effusions to determine the etiology of the pleural effusion 3
Treatment Options
- Treatment of pleurisy depends on the underlying cause, and may include antibiotics for bacterial infections, or other specific treatments for conditions such as pneumonia or malignancy 2, 4, 3
- Azithromycin in combination with ceftriaxone may be effective in reducing systemic inflammation and providing a survival benefit in cases of polymicrobial sepsis 5
- Pleural effusion management depends on the etiology, and may include drainage, pleurodesis, or treatment of the underlying medical disorder 3