MANAGEMENT OF CHILDHOOD EMPYEMA: EVALUATION OF 50 CASES

Abstract

To determine the long term outcome of different treatment modalities in pediatric empyema, 50 postpneumononic empyema cases admitted to our Pediatric Surgery Department between September 1, 1988 and September 1, 1990 were evaluated. Until aspirate cultures and antibiotic sensitivity results were obtained, a broad spectrum antibiotic therapy consisting of Sulbactam+Ampicillin, Amikacin or Netilmicin and Ornidazole was administered and in resistant cases the therapy was changed to Vancomycin or Piperacillin according to bacteriological results. The initial choice of treatment was closed tube drainage in 39 (%78) of cases, thoracotomy with decortication in 9 (%18) of cases and antibiotic administration in 2 (%4) cases with pneumatoceles. Decortication was required in 6 closed tube drainage cases due to incomplete expansion of the lung and 3 cases required a second decortication. One child died 3 hours after admission to the clinic and closed tube drainage.

According to our results, proper antibiotic therapy and closed tube drainage is a successful treatment modality in pediatric empyema, but in cases with persistent respiratory distress, multiple loculations with pleural thickening or ineffective chest tube drainage lasting for one week, thoracotomy and decortication must be considered as the appropriate choice of therapy.