From the Guidelines
Sympathetic pneumonic effusion, also known as sympathetic pleural effusion, should be treated with antibiotics targeting the causative organism, and small, uncomplicated effusions can be managed with antibiotic therapy alone, while larger effusions require drainage via thoracentesis or chest tube placement. The diagnosis of sympathetic pneumonic effusion involves confirming the diagnosis of pneumonia and parapneumonic effusion, and then categorizing the size of the effusion [ 1 ]. The management of pneumonia with parapneumonic effusion involves treating with antibiotics, and the duration of antibiotic treatment depends on the adequacy of drainage and on the clinical response demonstrated for each patient [ 1 ].
Diagnosis and Treatment
The diagnosis of sympathetic pneumonic effusion requires a combination of clinical evaluation, imaging studies, and laboratory tests. The treatment of sympathetic pneumonic effusion involves a multidisciplinary approach, including antibiotics, drainage of the effusion, and supportive care. The choice of antibiotic therapy should be based on the suspected or confirmed causative organism, and the duration of treatment should be individualized based on the patient's response to therapy [ 1 ].
Management of Parapneumonic Effusion
The management of parapneumonic effusion involves a step-wise approach, starting with the confirmation of the diagnosis and the categorization of the size of the effusion. Small, uncomplicated effusions can be managed with antibiotic therapy alone, while larger effusions require drainage via thoracentesis or chest tube placement [ 1 ]. The use of fibrinolytic agents or video-assisted thoracoscopic surgery (VATS) may be considered in patients with complicated effusions or those who do not respond to initial treatment [ 1 ].
Key Considerations
- The size of the effusion is a critical factor in determining the management approach, with small effusions typically managed with antibiotic therapy alone, and larger effusions requiring drainage [ 1 ].
- The choice of antibiotic therapy should be based on the suspected or confirmed causative organism, and the duration of treatment should be individualized based on the patient's response to therapy [ 1 ].
- The use of fibrinolytic agents or VATS may be considered in patients with complicated effusions or those who do not respond to initial treatment [ 1 ].
From the Research
Diagnosis of Sympathetic Pneumonic Effusion
- The diagnosis of sympathetic pneumonic effusion, also known as sympathetic pleural effusion, is typically made based on the presence of a pleural effusion on chest X-ray (CXR) or ultrasound in a patient with pneumonia 2.
- The diagnosis can be guided by the biochemical, microbiological, and radiological characteristics of the pleural effusion 2.
- Positive cultures are only obtained in 56% of cases, therefore, empirical antibiotics should provide Gram-positive, Gram-negative, and anaerobic cover whilst providing adequate pleural penetrance 2.
Treatment of Sympathetic Pneumonic Effusion
- The treatment of sympathetic pneumonic effusion typically involves the use of antibiotics, with the choice of antibiotic depending on the suspected or confirmed causative organism 3.
- Empirical antibiotics such as ceftriaxone plus azithromycin or levofloxacin may be used to treat community-acquired pneumonia (CAP) with pleural effusion 4, 5.
- The duration of antibiotic therapy can vary, but studies have shown that 7-10 days of therapy may be sufficient for uncomplicated CAP 6.
- In some cases, tube thoracostomy may be necessary to drain the pleural effusion, especially if it is complicated or empyema is present 2.
- Other treatments such as intrapleural fibrinolysin and DNase, surgery, and adjunct therapies like local anaesthetic thoracoscopy and indwelling pleural catheters may also be considered in certain cases 2.