Spontaneous Bacterial Empyema — SCE Infectious Diseases MCQ

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HardRespiratory InfectionSpontaneous Bacterial EmpyemaSCE Infectious Diseases

A 65-year-old man with alcoholic cirrhosis develops spontaneous bacterial empyema (infected pleural effusion without pneumonia). Pleural fluid culture grows E. coli. He has a known penicillin allergy (anaphylaxis). What is the most appropriate antibiotic?

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Correct answer: D — IV Ciprofloxacin 400 mg BD (or IV Meropenem if severe)

Spontaneous bacterial empyema (SBEM) in cirrhosis is analogous to SBP — it occurs by haematogenous seeding rather than parapneumonic spread. Treatment follows similar principles to SBP: IV antibiotics covering enteric Gram-negatives. With true penicillin anaphylaxis, IV Ciprofloxacin or IV Meropenem (low cross-reactivity in anaphylaxis) are appropriate alternatives to Ceftriaxone. A chest drain is not routinely required for SBEM unless there is a large, complicated collection.

Reference: EASL 2024 – Cirrhosis complications; BSG 2021 – Ascites and related infections