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Letters to the editor
BTS guidelines for the management of pleural infection
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  1. H S A Roberts1,*
  1. 1Consultant Microbiologist, Princess Royal University Hospital, Farnborough Common, Orpington, Kent BR6 8ND, UK; honor.roberts@bromleyhospitals.nhs.uk
  1. Correspondence to:
    Dr R J O Davies
    Churchill Hospital, Headington, Oxford OX3 7LJ, UK; robert.daviesndm.ox.ac.uk

https://doi.org/10.1136/thorax.2003.013094

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    We have read the BTS guidelines for the management of pleural infection1 and are concerned about the proposed antibiotic choices for the initial treatment of culture negative or pending pleural infection. Section 2.8 of the text and table 2 detail the antibiotic choices but, in our opinion, leave considerable gaps in antibacterial cover against the likely pathogens. In particular:

    • Amoxycillin (text) is not reliably active against Staphylococcus aureus.

    • Clindamycin has no activity against Gram negative aerobic organisms (especially not Haemophilus influenzae as mentioned in the text).

    • Benzyl penicillin (table) rarely now has activity against Staphylococcus aureus and we suggest that relying on ciprofloxacin is unwise. In addition, this combination will not cover many anaerobic bacteria.

    • We do not consider chloramphenicol is an appropriate agent to use in this category of patients in view of the serious side effect profile.

    • Third generation cephalosporins such as ceftazidime and cefotaxime have unreliable activity against many anaerobic bacteria.

    • Pneumococci are considerably less susceptible to ceftazidime than to other cephalosporins and penicillins …

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