Complicated Pneumonia (parapneumonic effusions, empyemas)
S. pneumoniae, S. pyogenes, MSSA/MRSA, H. influenza, M. catarrhalis
Ceftriaxone 50mg/kg/dose IV q24h (max 2000mg/dose)
AND
Clindamycin 40mg/kg/day IV div q8h (max 600mg/dose)⁸
If requiring ICU level care, REPLACE Clindamycin with Vancomycin [see dosing recommendations in Bugs and Drugs Section]
Empiric Therapy & Alternative Regimens
Duration of Therapy & Clinical Pearls
Management of Pneumonia with Parapneumonic Effusion
CXR, Chest US (preferred), and, in some circumstances, Chest CT can help to assess presence and severity of effusions.
Consult Infectious Diseases if large effusion or empyema is noted or if patient has worsening respiratory status despite 48 hours of ceftriaxone and clindamycin.
Consult General Surgery for moderate-large pleural effusions or empyema that may require drainage.
Pleural Fluid Testing: Gram Stain, bacterial culture, WBC count w/cell differential are important to obtain from drained pleural fluid.
IV to PO transition:
Consider once afebrile 24-48 hours and any chest drains removed.
Length of Therapy (IV+PO):
Minimum of 7 days, often requires extended course of antibiotics depending on severity of infection, discuss with infectious diseases.³