From the Research
For suspected empyema, antibiotics should typically be given for a total duration of 2-6 weeks, with the exact duration depending on clinical response, as supported by the most recent study 1. The management of empyema involves a combination of antibiotic therapy and drainage procedures. Initially, broad-spectrum intravenous antibiotics should be started empirically, often including coverage for both aerobic and anaerobic organisms. Common regimens include a combination of a beta-lactam (such as piperacillin-tazobactam, ampicillin-sulbactam, or a carbapenem) plus an agent covering MRSA (like vancomycin or linezolid) if risk factors exist.
- Key points to consider in the management of empyema include:
- The use of anti-anaerobic antibiotics, which has been associated with lower readmission rates for empyema and all-cause readmission 1
- The potential to switch to oral antibiotics after 1-2 weeks of IV therapy, depending on clinical improvement and the availability of oral antibiotics with good bioavailability that match the susceptibility of identified pathogens
- The importance of drainage procedures, such as thoracentesis, chest tube placement, or surgical intervention, in addition to antibiotic therapy, as these are essential components of empyema management 2
- The extended antibiotic duration is necessary because empyema represents a complicated infection with poor antibiotic penetration into the pleural space and potential biofilm formation that makes bacterial eradication more difficult.
- A study from 2022 1 analyzed antibiotic use and clinical outcomes in adults with known and suspected pleural empyema, and found that longer total antibiotic duration was associated with lower readmission rate for empyema, and longer duration of anti-anaerobic antibiotics was associated with both lower all-cause readmission and lower readmission rate for empyema.