Pediatric Empyema Medication

  • Author: Peter H Michelson, MD; Chief Editor: Michael R Bye, MD   more...
 
Updated: Mar 5, 2012
 

Medication Summary

Individualize intravenous antibiotics by both age and likelihood of the offending organism. In the case of a possible aspiration, such as in the patient who is debilitated or neurologically impaired, consider coverage for anaerobic infection.

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Antibiotic, cephalosporin (second generation)

Class Summary

These agents are recommended for the most likely bacterial infections; the specific agent selected should be individualized based on the offending organism. They may include, but are not limited to, the following:

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Cefuroxime (Zinacef)

 

A second-generation cephalosporin with good coverage for most staphylococcal and streptococcal organisms, which are the most common community-acquired causative agents; thus, this is the most often selected initial antibiotic.

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Antibiotics, anaerobic infections

Class Summary

In situations in which an aspiration or likely anaerobic infection is the cause of the pneumonia, coverage for anaerobes is recommended.

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Clindamycin (Cleocin)

 

Provides coverage for gram-positive organisms and anaerobes and is a possible agent for infections in patients at high risk for having aspirated PO contents as a cause of their infection.

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Antibiotic, Miscellaneous

Class Summary

Vancomycin may be considered when methicillin-resistant S aureus is suspected or confirmed.

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Vancomycin (Vancocin, Vancoled)

 

Classified as glycopeptide agent that has excellent gram-positive coverage, including methicillin-resistant S aureus. To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dosing. Use creatinine clearance to adjust dose in patients diagnosed with renal impairment.

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Thrombolytic agents

Class Summary

These agents convert plasminogen to plasmin, leading to clot lysis. These agents are used to lyse adhesions in the pleural space.

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Alteplase (Activase)

 

Tissue plasminogen activator exerts effect on fibrinolytic system to convert plasminogen to plasmin. Binds to fibrin in a thrombus and converts the entrapped plasminogen to plasmin, thereby initiating local fibrinolysis. Serum half-life is 4-6 min, but half-life is lengthened when bound to fibrin in clot. Used to restore function of central venous access devices that have become occluded due to thrombosis. Circulating plasma levels are not expected to reach pharmacologic concentrations.

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Contributor Information and Disclosures
Author

Peter H Michelson, MD  Associate Professor of Pediatrics, Division of Pulmonary and Sleep Medicine, Duke University School of Medicine

Peter H Michelson, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and International Society for Heart and Lung Transplantation

Disclosure: Nothing to disclose.

Specialty Editor Board

Thomas Scanlin, MD  Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School

Thomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO  Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

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Radiographic imaging of a parapneumonic effusion may be useful in assessing the stage of the effusion and the type of drainage needed. In Figure A, the left heart border is obscured, and more than 50% of the left hemithorax is filled with an effusion, as evidenced by a fluid meniscus. In Figure B, the effusion is demonstrated to be fluid because it layers out on a decubitus film. In Figure C, the lateral radiograph again demonstrates the fluid meniscus and filling of the posterior sulcus. These findings suggest tube thoracostomy placement may be sufficient to drain this pleural process.
Most parapneumonic effusions treated with the appropriate antimicrobials of sufficient duration resolve without the development of complications or sequelae. The series of radiographs represent a patient treated with thoracentesis alone. Figure A illustrates the patient at presentation. Note the amount of fluid present. In Figure B, the radiograph demonstrates progression of the pleural fluid accumulation with further airspace disease and scoliosis noted. Despite the radiographic evidence of disease progression, the patient was clinically improving. Figure C illustrates the radiograph at follow-up, 6 months following completion of therapy. Resolution of the parapneumonic effusion with no evidence of pleural thickening or fibrosis occurred.
 
 
 
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