Medicines for Empyema

What it is

An empyema is a collection of infected fluid and pus in the pleural space — the thin space between the lung and the chest wall. It most commonly develops as a complication of pneumonia (a lung infection): sometimes the infection spreads into the surrounding fluid, which becomes infected and turns to pus. Less commonly, it can follow chest surgery, injury, or other infections. Empyema is a serious condition, because the pus around the lung can prevent the lung expanding properly, worsen the infection, and make the person very unwell. Symptoms often include those of a chest infection that is not settling or is worsening despite treatment — such as a persistent or high fever, chest pain (often worse on breathing), breathlessness, cough, and feeling increasingly unwell, tired and off food. It should be suspected particularly when someone with pneumonia is not improving as expected. Because the pus needs to be drained as well as the infection treated, empyema needs hospital care, and prompt recognition and treatment are important for recovery.

How it is treated

Empyema is treated in hospital, and management has two essential parts: treating the infection and draining the pus. Antibiotics are given (often into a vein, and usually for a prolonged course) to treat the underlying infection. Crucially, because antibiotics alone often cannot clear a collection of pus, the infected fluid needs to be drained — most commonly by inserting a tube (chest drain) through the chest wall into the pleural space to drain the pus, sometimes with additional medicines instilled through the drain to help break up thick collections. Imaging (such as a chest X-ray, ultrasound or CT scan) guides diagnosis and drainage. In some cases, where drainage is not sufficient or the pus is thick and organised, a surgical operation is needed to clean out the infected space and free the lung. Supportive care (such as oxygen, fluids, and treating the person's general condition) is important, as empyema can make people seriously unwell. Recovery can take time, with follow-up to ensure the infection clears and the lung re-expands. The reassuring message is that empyema, though a serious infection, is treatable with prompt hospital care — antibiotics combined with draining the pus (and, in some cases, surgery) — and most people recover with appropriate treatment.