Management of parapneumonic pleural effusions and empyema

Parapneumonic pleural effusions, the most common causes of exudative pleural fluid, are a frequent finding with bacterial pneumonia. Progression to empyema is related to delay in appropriate antimicrobial therapy. Once an empyema develops, therapy consists of early sterilization of the empyema space with appropriate antibiotics, early and adequate pleural space drainage, and obliteration of the empyema cavity by adequate lung expansion, surgical decortication, or enzymatic debridement.