Empyema/effusion Rx

Therapy should be for 4wks or more depending on clinical response/adequacy of chest drainage.

Continue antimicrobial regimen based on either respiratory sample microbiology or empiric pneumonia coverage

Complicated effusions/empyema always require empiric anaerobic coverage. Anaerobic coverage can be discontinued if certain pathogens such as S. pneumoniae or S. aureus cultured from pleural fluid

Avoid aminoglycosides due to relative inactivity in acidic environments