Parapneumonic empyema (PPE) is an important complication of pediatric pneumonia and leads to prolonged hospitalization and substantial short-term morbidity. Over the past decade, there has been vigorous debate into the optimal management of such patients leading to marked variation in care. Most of the debate has focused on the optimal drainage procedure, focusing on clinical trials that have assessed the relative merits of chest tubes with instillation of fibrinolytic agents compared with surgical approaches, such as video-assisted thorascopic surgery. Relatively less attention has been paid to important questions related to the medical management of these patients, especially those that address the route and duration of antimicrobial therapy. In terms of outpatient therapy duration, current national guidelines recommend 2 to 4 weeks of outpatient therapy (Pediatric Infectious Diseases Society [PIDS] and Infectious Diseases Society of America [IDSA]).
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