From the Guidelines
The initial management of pleurisy should focus on treating the underlying cause, providing symptomatic relief, and administering antibiotics as soon as possible, with the choice of antibiotics guided by bacterial culture results or covering community-acquired bacterial pathogens and anaerobic organisms if cultures are negative 1. The treatment approach may vary depending on the underlying cause of pleurisy, which can range from viral infections to bacterial pneumonia, tuberculosis, autoimmune conditions, or pulmonary embolism.
- For bacterial causes, antibiotics such as a second-generation cephalosporin (e.g., cefuroxime) or an aminopenicillin (e.g., amoxicillin) should be prescribed, along with a beta-lactamase inhibitor or metronidazole to cover penicillin-resistant aerobes and anaerobes 1.
- For viral pleurisy, supportive care with rest, adequate hydration, and pain management using nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen is recommended 1.
- If pleural effusion is present, thoracentesis may be performed for both diagnostic and therapeutic purposes, and the initial drainage of pleural infection should be undertaken using a small bore chest tube (14F or smaller) 1. Key considerations in the management of pleurisy include:
- Patient choice and informed decision-making regarding treatment modalities, including inpatient versus ambulatory management 1.
- The potential risk of requiring further pleural interventions and the importance of deep breathing exercises to prevent atelectasis. Overall, the prognosis for pleurisy varies significantly depending on the underlying cause, with viral pleurisy typically resolving within a few weeks with appropriate symptomatic management.
From the Research
Initial Management and Treatment of Pleurisy
The initial management and treatment of pleurisy involve identifying the underlying cause of the condition and addressing it accordingly.
- The first step in evaluating patients with pleurisy is to determine whether the pleural effusion is a transudate or an exudate, as this helps in guiding the treatment approach 2.
- For transudative effusions, therapy should be directed towards the underlying heart failure or cirrhosis 2.
- For exudative effusions, attempts should be made to define the etiology, with common causes including pneumonia, cancer, tuberculosis, and pulmonary embolism 2.
Role of Corticosteroids in Treatment
Corticosteroids may be used in the treatment of pleurisy, particularly in cases of tuberculous pleurisy.
- Research suggests that corticosteroids may reduce the time to resolution of pleural effusion and the risk of residual pleural effusion 3.
- However, the use of corticosteroids is not without risks, and the potential benefits must be weighed against the potential adverse effects, particularly in HIV-positive individuals 3.
Specific Treatment Approaches
Specific treatment approaches may vary depending on the underlying cause of the pleurisy.
- In cases of tuberculous pleurisy, standard anti-tuberculous therapy and early complete drainage of the effusion may be adequate for treatment 4.
- In cases of microscopic polyangitis with pleuritis, treatment with prednisolone, cyclophosphamide, and plasma exchange may be effective 5.
- In general, the treatment approach should be individualized based on the specific needs and circumstances of the patient, taking into account the underlying cause of the pleurisy and any potential comorbidities or complications 6.