Treatment of uncomplicated parapneumonic effusion

* While most uncomplicated effusions may be treated with antibiotics alone, there may be an indication for drainage in select circumstances. For example, drainage may need to be considered when it is thought that the effusion is causing symptoms (especially in patients with poor underlying respiratory reserve) or in patients in whom the effusion is a suspected source of infection. A 7-day course of antibiotics is often sufficient and in most cases anaerobic coverage is not needed.
¶ A good clinical response is one where symptoms and signs (eg, fever and leukocytosis) improve. Radiographic improvement generally takes longer than 2 to 4 days, especially if a drain is not in place. However, an uncomplicated parapneumonic effusion should not worsen (eg, increase in size and/or development of worsening symptoms). Worsening clinical or radiographic features suggest the development of a complicated parapneumonic effusion.
Δ This typically involves imaging by contrast chest computed tomography and culture (or re-culture) of pleural fluid.