QuestionSBA
QuestionChoice
The appropriate treatment is drainage to avoid empyema development. The streptococcus is sensitive to penicillin therefore a change in antibiotic or the way in which it is administered is very unlikely to yield any significant results.
10003510
e
Switch benzylpenicillin to ceftriaxone
QuestionChoice
The streptococcus is sensitive to penicillin therefore a change in antibiotics or the way in which it is administered is very unlikely to yield any significant results.
10003508
c
Inject antibiotic into the effusion
QuestionChoice
The appropriate treatment is drainage to avoid empyema development. The streptococcus is sensitive to penicillin therefore a change in antibiotic or the way in which it is administered is very unlikely to yield any significant results.
10003509
d
Increase the dose of penicillin
QuestionChoice
This is because the Gram stain and low pH indicate a complex parapneumonic effusion (pleural effusion that develops next to a pneumonia). The appropriate treatment is drainage of the effusion as it is likely developing into an empyema. Streptococcus is sensitive to penicillin, therefore a change in antibiotics is very unlikely to yield any significant results.
10003506
a
Drainage of the effusion
QuestionChoice
The goal of pleurodesis is to try to adhere the linings of the lung (pleura) together in order to stop further fluid or air build-up. This is achieved by inserting sterile talc into the area between the lung and the inside of the chest wall. It is indicated in recurrent pleural effusions and persistent pneumothoraces.
10003507
b
Talc pleurodesis
Concept
Chapter
2693
3709
Pneumonia
Topic
132
Respiratory
13248
A 40-year-old female has a left lower lobe pneumonia. Blood cultures are positive for a penicillin-sensitive *Streptococcus pneumoniae*. She is managed with IV benzylpenicillin. She improves but on the fourth day of treatment, she becomes pyrexic and has increased dyspnoea.

A chest x-ray shows a left basal effusion. Purulent fluid is aspirated and analysis of the fluid shows a pH of 6.80 (reference range 7.35 – 7.45) and Gram-positive cocci.

What is the most appropriate next step in managing this patient?
a