PENICILLIN TREATMENT OF EMPYEMA: REPORT OF 24 CASES AND REVIEW OF THE LITERATURE

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Abstract
The salient features of a series of 24 cases of ernpyema treated with aspiration and penicillin given intrapleurally and intramusc. were presented and the results in similar cases collected from the literature were analyzed. Between 50 and 65% of em-pyemata due to pneumococcus, hemolytic streptococcus and staphylococcus were completely cured without operative drainage, but fewer putrid empyemas and cases of mixed infections were so cured. The patients improved markedly after penicillin and aspirations were started, and cases of putrid empyema were better operative risks after this therapy. Ernpyema fluid was rapidly sterilized and purulent cases lost their odor promptly, but other changes were not uniform after penicillin. The hospital course and convalescence were considerably shorter if operation was avoided. After intra-pleural injn. of penicillin in amts. of 50,000 units or more, significant levels are maintained in the blood for several hrs., the conc. and duration depending on the size of the dose and probably on the size and character of the empyema cavity. Systemic therapy is probably not essential in most cases, particularly if intrapleural injns. of 100,000 units or more are given at 24- or 48-hr, intervals.