Treatment Overview
A diagnosis of empyema can be alarming, as it involves a collection of pus in the pleural space, the thin area between the lung and the inner chest wall. Often a complication of pneumonia, this severe infection causes symptoms like high fever, sharp chest pain, and shortness of breath, making simple activities deeply uncomfortable. Because the infected fluid restricts the lung’s ability to fully expand, empyema significantly impacts normal breathing and requires urgent, decisive care.
Treatment is critically important to prevent life-threatening complications like sepsis (blood poisoning) and to stop the infection from causing permanent scarring (fibrosis) that can trap the lung and severely limit its function. Successful management depends on eliminating the infection and physically removing the thick, infected fluid. The choice of medication is tailored to the severity of the infection and the specific type of bacteria identified (Centers for Disease Control and Prevention, 2022).
Overview of treatment options for Empyema
The treatment of empyema always involves a two-pronged approach: medication to kill the bacteria, and procedures to drain the pus. Neither approach is effective on its own in most cases.
The primary goal is to eradicate the bacteria and rapidly restore the function of the pleural space. Initially, medication is administered intravenously while the patient is hospitalized. A procedure, typically inserting a chest tube, is usually required to drain the infected fluid. If the pus is too thick to drain easily, additional medication (fibrinolytic agents) may be introduced directly into the chest tube to dissolve the sticky material. In chronic or complicated cases where the pus has hardened into membranes, video-assisted thoracic surgery (VATS) may be needed to physically clean the pleural space.
Medications used for Empyema
Antibiotics are the foundation of medical treatment for empyema. Since the infection is often serious and requires immediate intervention, treatment usually begins with broad-spectrum antibiotics, drugs that target a wide range of potential bacteria before the specific microbe is identified.
Initial regimens often include combinations of antibiotics to cover both aerobic (oxygen-using) and anaerobic (non-oxygen-using) bacteria, as empyema frequently involves a mix of organisms. Examples of drugs used include penicillin-derived antibiotics, cephalosporins, and agents targeting anaerobes like clindamycin or metronidazole. The course of treatment is long, typically lasting several weeks, starting with IV administration and transitioning to oral medication once the patient stabilizes.
A second, specialized class of medications is the intrapleural fibrinolytic agents, such as alteplase. These drugs are not taken by mouth or intravenously; they are instilled directly into the pleural space through the chest tube. They are often combined with dornase alfa, another agent that breaks down thick DNA proteins in the pus (MedlinePlus, 2023).
How these medications work
Antibiotics function by attacking the bacteria’s vital structures. Most commonly, they disrupt the formation of the bacterial cell wall or interfere with the bacteria’s ability to synthesize proteins. This causes the bacteria to die, clearing the active infection. Consistent, prolonged use is required to ensure every last bacterium is eliminated from the deep tissue.
Fibrinolytic agents play a crucial role by assisting the physical drainage process. During empyema, the infected fluid forms thick, web-like strands of fibrin that create pockets of pus, preventing a chest tube from draining the area completely. Fibrinolytic medications dissolve these fibrin strands and the thick material, effectively liquefying the pus and allowing it to be removed, thereby ensuring the lung can re-expand fully.
Side effects and safety considerations
Antibiotics commonly cause side effects like nausea, vomiting, or diarrhea. Monitor patients closely for severe allergic reactions (rash, hives, difficulty breathing). Prolonged use risks secondary infections, such as severe diarrhea from Clostridium difficile.
Fibrinolytic agents, instilled directly into the chest, may cause temporary chest pain or rare, localized bleeding. Patients must complete the full antibiotic course, even if symptoms subside, to fully eradicate the infection and prevent drug resistance.
Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.
References
- Centers for Disease Control and Prevention. https://www.cdc.gov
- Mayo Clinic. https://www.mayoclinic.org
- MedlinePlus. https://medlineplus.gov
- American Thoracic Society. https://www.thoracic.org
Medications for Empyema
These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Empyema.