Bradley et al outlined options for managing a young pediatric patient with community-acquired pneumonia (CAP) and a parapneumonic effusion or empyema. The duration of antibiotic therapy varies considerably and should be individualized for the patient. The authors are from the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America.

Patient selection: infant > 3 months of age or child with CAP and a parapneumonic effusion or empyema


Therapy involves parenteral antibiotics. The selection of parenteral antibiotics should be based on susceptibility testing of isolates from blood or pleural fluid, if available. If blood and pleural fluid are sterile then therapy is based on susceptibility of respiratory tract isolates if available.


Duration of therapy varies and may be:

(1) fixed duration (2 to 4 weeks)

(2) 10-14 days after resolution of fever


Factors affecting therapy:

(1) adequacy of the drainage procedure

(2) persistence of clinical signs and symptoms

(3) problematic isolates such as MRSA

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