Empyema Thoracis - Procedures, Side effects, Recovery time, Costs and alternatives

The treatment for empyema thoracis is done in the following order:

• Medication: As soon as the doctor confirms his/her diagnosis of empyema thoracis an oral antibiotic treatment is started for the patient. Then a sample of the fluid which is taken from the pleural space of the patient is sent for the finding out the organism. Based on the organism found in the culture test of the fluid an antibiotic treatment is started. A doctor makes the choice of antibiotics based on the antibiotics given in the culture test to destroy the organism and the ability of the antibiotic to penetrate through to the pleural space. Initially, the doctor may start the antibiotic treatment intravenously for a period of 5 days followed by oral antibiotic therapy for a period of 7 days. The number of days for antibiotic treatment may vary based on the severity of the condition of the patient.
• Surgery: A doctor may advise a surgical treatment for the condition of empyema thoracis. The following surgical treatments may be prescribed
• Thoracostomy: this is a surgical procedure wherein a plastic tube is inserted between two ribs of the chest. The tube which is inserted into the pleural space is connected to a suction device which sucks the fluid out. Rather than sucking out the fluid medicines may also be injected for draining out the fluid.
• Decortication: this is a surgical procedure wherein a surgeon removes the pleural peel covering the lungs. This thick, inelastic pleural peel does not allow the chest to expand normally.
• Video-assisted thoracic surgery: in this surgical procedure the surgeon conducts the surgery by making small incisions in the chest of the patient. A video camera is inserted into the chest using these incisions. The surgeon would eliminate the affected tissue around the lung followed by draining the fluid using a tube.

A patient is considered eligible for the treatment of empyema thoracis if the patient is exhibiting the following symptoms :

• A patient would have a high fever with chills.
• A patient would experience chest pain while breathing.
• Shortness of breath is exhibited by the patient.
• A patient experiences loss of weight.
• The blood pressure of the patient would be low.
• A patient would have an abnormally high heart rate.

Besides the presence of these symptoms, a doctor may order some tests like a chest x-ray, and ultrasound. If these reports of the patient confirm the presence of the fluid in the pleural space then he/she is considered eligible for the treatment.

A patient that does not have any fluid present in their pleural space is not eligible for the treatment. Besides the confirmation of the disease, a patient may be considered not eligible for a treatment based on their medical history. For example, a patient who may be allergic to the use of antibiotics is not eligible for his/her treatment with an antibiotic. A patient that has a compromised immune system is not eligible for treatment through a surgical procedure.

Benefits and side effects are a part of any treatment which may be given to a patient. The side effects of a treatment range from being mild to severe. The side effects usually vary from a patient to patient. If a patient experiences a mild side effect then in the majority of the cases the side effect gets subsided after a short period of time. A patient experiencing a severe side effect may need emergency medical attention.

The side effects experienced by a patient after intravenous treatment through antibiotics are swelling at the intravenous site, pain, and nerve damage. While using an antibiotic for the treatment of empyema thoracis a patient might experience the following side effects

• Pain in the abdomen
• Flatulence
• Loose Motions
• Feeling of vomiting
• Loss of appetite
• Improper digestion.

The side effects associated with the surgical treatment of empyema thoracis are given below :

• A patient may suffer from an infection at the surgical site.
• There may be a chance of leakage of air.
• The lungs of the patient may get damaged.
• A bleeding problem may arise.
• A nerve may get damaged during the surgical procedure.In case any of these side effects persists or there any other health issues arising during or after treatment, it is advised to kindly consult the health specialist immediately.

The post-treatment guidelines play a very important role in the complete recovery of a patient. Apart from the recovery the post-treatment guidelines also help in preventing the disease from occurring in the future. The post-treatment guidelines that are required to be followed after the treatment of empyema thoracis are :

• The antibiotic prescribed by the doctor must be taken as advised and a complete course of the antibiotics must be done even if the patient has completely recovered.
• The surgical site must be cleaned with sterile cotton and must be covered with sterile bandages.
• The pain medications must be taken as per the advice of the doctor.
• In case any discomfort is experienced by the patient a doctor must be informed immediately.

The recovery of the patient from empyema thoracis from antibiotic treatment depends on the duration of the treatment which is usually 2 to 6 weeks based on the severity of the infection. The recovery of a patient after the surgical procedure likethoracostomy would take nearly 1 to 2 months for complete recovery while in the procedure like VATS the patient gets recovered within 2 to 3 weeks.

The cost of an intravenous antibiotic in India ranges from 250 to 1500 rupees per injection. The variance in the cost of antibiotics is due to the power and salt of the injections. The cost of oral antibiotics in India ranges from 150 rupees to 500 rupees. The cost of surgical treatment in India depends upon the experience of the surgeon, the type of surgery, and the location of the hospital. The cost of the surgery thus may vary from 1 lakhs to 7 lakhs.

The results of the treatment are not permanent as there is a chance that empyema thoracis may occur again in the future. The treatment which is given only cures only the present condition. However, if proper precautions are taken then the disease can be prevented from occurring in the future.

Apart from the treatment described above for empyema thoracis, a doctor may give an option of alternate treatment through intrapleural fibrinolytic drugs. This treatment is usually preferred in older patients who cannot undergo surgery due to their age.