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Paediatric Pulmonology and Allergology
2008 April, Vol. XI, No. 1 (3836-3848)
TREATMENT APPROACHES FOR EMPYEMA IN CHILDREN
Samatha Sonnappa1, Adam Jaffe2
1Portex Respiratory Unit, Great Ormond Street Hospital and Institute of Child Health London, UK; 2Sydney Children’s Hospital and School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia
Empyema is an important cause of childhood morbidity with an increasing worldwide incidence. Therapeutic options currently available include: systemic antibiotics alone or in combination with thoracocentesis; chest drain insertion, with or without instillation of fibrinolytic agents; and surgical techniques such as video-assisted thoracoscopic surgery, mini-thoracotomy, and standard thoracotomy with decortication. Despite many treatment options being available, there is no general consensus on the optimal management approach due to conflicting reports and lack of properly conducted studies to challenge the personal bias of a physician or surgeon. The reason for this is likely to be the fact that, irrespective of the treatment children receive, differently from adult population, where mortality is uo to 20%, they ultimately make an excellent clinical recovery. This review summarises the current evidence and evaluates the clinical efficacy of various treatment modalities in the context of relevant outcome measures (current best primary outcome measure is the length of stay) in an attempt to demonstrate the differences in treatment options for the child with empyema. Currently not the last among outcome measures is cost of treatment. Also we will briefly review the prevention against the primary cause of community acquired pneumonia and empyema – Streptococcus pneumoniae (Paediatric Respiratory Reviews 2007; 8: 164–70; translation and publication with permission).