What are the clinical treatment guidelines for pleurisy?

From the Guidelines

The treatment of pleurisy should focus on addressing the underlying cause while managing pain and inflammation, with initial drainage of pleural infection undertaken using a small bore chest tube (14F or smaller) as recommended by the British Thoracic Society guideline for pleural disease 1. The management of pleurisy involves a multifaceted approach, including:

• Analgesics such as NSAIDs (ibuprofen 400-600mg every 6-8 hours or naproxen 500mg twice daily) to reduce pain and inflammation
• Antibiotics for bacterial infections, with regimens such as amoxicillin-clavulanate 875/125mg twice daily, levofloxacin 750mg daily, or ceftriaxone 1-2g daily for 7-14 days depending on severity and response 1
• Standard anti-TB therapy (isoniazid, rifampin, ethambutol, and pyrazinamide) for 6-9 months for tuberculous pleurisy
• Supportive care for viral pleurisy
• Thoracentesis for diagnostic and therapeutic purposes if significant pleural effusion is present
• Pleural drain placement for recurrent effusions
• Patient education on rest and breathing exercises to prevent atelectasis
• Follow-up chest imaging to ensure resolution The British Thoracic Society guideline for pleural disease recommends a patient-centered approach, with decisions on treatment modality based on patient choice and informed decision-making 1. Key considerations in the management of pleurisy include:
• The importance of prompt and effective treatment to reduce morbidity and mortality
• The need for specialist involvement in the care of patients with pleural infection 1
• The role of antibiotics in managing bacterial infections, with guidance on empiric treatment and the importance of culture results 1
• The use of small bore chest tubes for initial drainage of pleural infection, as recommended by the British Thoracic Society guideline for pleural disease 1.

From the Research

Clinical Treatment Guideline for Pleurisy

• The treatment of pleurisy largely depends on its cause, and precise differential diagnostic categorization is essential 2.
• The most common causes of pleural effusion, which is often associated with pleurisy, are congestive heart failure, cancer, pneumonia, and pulmonary embolism 2.
• Pleural fluid puncture (pleural tap) enables the differentiation of a transudate from an exudate, which is the foundation of the further diagnostic work-up 2.
• When a pleural effusion arises in the setting of pneumonia, the potential development of an empyema must not be overlooked 2.
• The specific treatment of pleural effusion ranges from pleurodesis, to thoracoscopy and video-assisted thoracoscopy, to the placement of a permanently indwelling pleural catheter 2.
• For patients with community-acquired pneumonia (CAP), which can cause pleurisy, the combination of a third-generation cephalosporin and a macrolide may be preferred over fluoroquinolones as first-line therapy to minimize the development of multiresistant nosocomial Gram-negative bacilli 3, 4.
• Monotherapy with oral Levofloxacin may be as effective as treatment with Ceftriaxone plus Azithromycin combination in patients with CAP who require hospitalization 4.