Treatment of uncomplicated parapneumonic effusion - UpToDate 11/8/19, 1:23 PM

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Treatment of uncomplicated parapneumonic

effusion

* While most uncomplicated effusions may be treated with antibiotics alone,

there may be an indication for drainage in select circumstances. For
example, drainage may need to be considered when it is thought that the
effusion is causing symptoms (especially in patients with poor underlying
respiratory reserve) or in patients in whom the effusion is a suspected source
of infection. A 7-day course of antibiotics is often sufficient and in most cases
anaerobic coverage is not needed.
¶ A good clinical response is one where symptoms and signs (eg, fever and
leukocytosis) improve. Radiographic improvement generally takes longer
than 2 to 4 days, especially if a drain is not in place. However, an
uncomplicated parapneumonic effusion should not worsen (eg, increase in
size and/or development of worsening symptoms). Worsening clinical or
radiographic features suggest the development of a complicated
parapneumonic effusion.
Δ This typically involves imaging by contrast chest computed tomography
and culture (or re-culture) of pleural fluid.

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