Would you consider deferring chest tube placement in a clinically stable patient with a small empyema without signs of systemic infection?

Firstly, diagnosing empyema means the fluid has already been diagnostically tested by thoracentesis.

If all the fluid was removed on the diagnostic tap, I would continue and complete the course of antibiotics with close follow-up. The duration of Antibiotics ranges from 4-6 weeks.

If a significant amount of fluid is still left after thoracentesis and/or there is CT imaging showing air/gas forming organism. Chest tube will be preferred.

Antibiotics do not have good penetration in the pleura.

Yes, in an outpatient to save hospitalization. However, requires prolonged PO antibiotics with close follow-up. Would get an ultrasound to confirm all fluid resorbed before stopping antibiotics.

For most hospital patients, seems little to gain by avoiding tube drainage and may shorten antibiotic course by using tube. R Bloom MD.