Protocol-driven Antibiotic Treatment of Pediatric Empyema After Fibrinolysis

Pediatr Infect Dis J. 2021 Jan;40(1):44-48. doi: 10.1097/INF.0000000000002872.


Background: The duration of antibiotic treatment after resolution of empyema in children is variable. We evaluated the efficacy and safety of a protocol-driven antibiotic regimen aimed to decrease antibiotic duration following treatment with fibrinolysis.

Methods: Our institutional protocol consisted of 7 further days of antibiotics upon removal of the thoracostomy tube, with the patient being afebrile, off supplemental oxygen, and having negative cultures. A prospective observational study was then performed between September 2014 and March 2019. Empyema recurrence and antibiotic-related complications were recorded. Results were compared with previously published data from the preprotocol era.

Results: A total of 37 patients were included. Mean total duration of antibiotics decreased from 26 ± 6.5 days in the preprotocol group to 22 ± 9.7 days in the postprotocol group (P = 0.004). This resulted in a significant decrease in hospital stay from the preprotocol cohort to the postprotocol cohort, respectively (9.3 ± 4.8 d versus 6.8 ± 3.1 d, P = 0.003). Sixty-two percentage of the patients were intended to treat according to the protocol, with a 50% adherence rate. Patients in which the protocol was followed had an average of 2.8 fewer days of antibiotics after discharge (P = 0.004), although overall duration was not statistically different. Significantly fewer antibiotic-related complications were noted after protocol initiation. There was no difference in empyema recurrence or readmissions.

Conclusions: Institution of a protocol-driven approach to antibiotic duration following resolution of pleural space disease may reduce antibiotic duration and complications without reducing efficacy.

Publication types

  • Observational Study

MeSH terms

  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / adverse effects
  • Anti-Bacterial Agents* / therapeutic use
  • Bacterial Infections / diagnosis
  • Bacterial Infections / drug therapy
  • Bacterial Infections / microbiology
  • Bacterial Infections / surgery
  • Child
  • Child, Preschool
  • Empyema, Pleural / diagnosis
  • Empyema, Pleural / drug therapy*
  • Empyema, Pleural / microbiology
  • Empyema, Pleural / surgery
  • Female
  • Humans
  • Infant
  • Length of Stay
  • Male
  • Prospective Studies
  • Thoracostomy
  • Thrombolytic Therapy*


  • Anti-Bacterial Agents