Pneumococcal empyema: outcome of medical management
D. Murphy, C. H. Lockhart and J. K. Todd
Physicians vary considerably in their opinion as to the duration of
hospitalization and degree of surgical intervention for children with
pneumococcal empyema. The development of pneumatoceles and persistence of
fever or loculated pleural fluid are causes of debate and concern. We
reviewed the records of 21 children with confirmed pneumococcal pneumonia.
Ten of the 12 with no pleural fluid became afebrile within 48 hours of
appropriate antibiotic therapy, whereas the nine with empyema remained
febrile an average of 7.1 days (minimum estimate) in spite of documented
sterile cultures within 24 hour in five of the patients. Although chest
tube and thoracentesis drainage could not remove all the pleural fluid, and
pneumatoceles developed in five of the nine children, long-term follow-up
studies including chest roentgenograms and pulmonary function testing
demonstrated a gradual but complete recovery that did not require long-term
hospitalization, continued parenteral antibiotic therapy, or invasive
surgical procedures.
