Pediatric Empyema Medication

Updated: Sep 30, 2016
  • Author: Peter H Michelson, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Medication

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:

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.

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.

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.

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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