Empyema

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Institute pleural drainage with a large intercostal tube and underwater seal.

Medicine	Adult dose	Frequency	Duration
benzylpenicillin iv	2.5MU	6 hourly	10-14 days
metronidazole po	400mg	3 times a day	10-14 days
Alternatively (alone):
amoxicillin-clavulanic acid po	625mg	3 times a day	10-14days

Also institute thromboprophylaxis with heparin/warfarin (refer to Haematology section of main Zimbabwe STG).

Note: If pus still drains after two weeks refer for surgical opinion.

If preceded by a suspected staphylococcal pneumonia use:

Medicine	Adult dose	Frequency	Duration
cloxacillin iv	1gm	6hourly	10-14 days
and metronidazole po	400mg	3 times a day	10-14 days

In HIV infection, also consider TB empyema especially