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© ERS 2017. Pleural infection remains a common and serious respiratory condition with important implications for patients and healthcare services. Diagnosis of the condition can be challenging and its management may require a multidisciplinary approach. Antibiotic therapy, along with pleural drainage, forms the cornerstone of treatment for pleural infection. Culture-positive samples (including both pleural fluid and blood) are found in ∼60% of patients and correct empirical therapy is of paramount importance. Evidence from RCT and case series data have shown that the combination of an intrapleural tissue plasminogen activator and DNase therapy can potentially improve outcomes, but further research is needed to establish the first-line use of such agents. In this chapter, we cover the management of pleural infections, including medical treatment, the role of intrapleural agents and surgical treatment, with a focus on the use of antibiotics.

Original publication




Journal article


ERS Monograph

Publication Date





253 - 263