What is the recommended treatment for empyema?

• A. Chest tube placement
• B. Oral antibiotics only
• C. Observation
• D. Thoracentesis without drainage

Answer: (A)

Empyema is pus in the pleural space, so the priority is source control by drainage. A chest tube provides continuous drainage of infected fluid from the pleural space, allowing antibiotics to work more effectively and helping to resolve the infection. Relying on oral antibiotics alone won’t clear the pus in the pleural space, and observation or thoracentesis without drainage won’t adequately treat the empyema. While thoracentesis can diagnose and temporarily relieve fluid, it typically isn’t sufficient for empyema, especially if the collection is loculated. In some cases, additional steps like intrapleural fibrinolytics or surgery may be needed, but the essential initial remedy is chest tube drainage.