Abstract: Background: Pleural effusions, parapneumonic effusions and empyema thoracis are known complications of bacterial pneumonia. Underlying disorders as well as treatment approaches dramatically reduce the rate of morbidity and mortality in children.

Methods: Forty-six children below 12 years of age admitted with pleural effusions or empyema thoracis between October 2015 and May 2019 were prospectively analysed. Daily thoracocentesis, intercostal tube drainage (ICD), open thoracotomy and decortication were performed among appropriate patients.

Results: During the study period 46 cases of pleural effusions or empyema thoracis were encountered. Commonest age group involved was 1-3 years (52.2%) and the youngest patient was a 7-month old boy. Male to female ratio was 1.7:1. In 72% of cases various combinations of oral and/or parenteral antibiotics were administered. Initial therapeutic intervention undertaken was serial thoracocentesis in 14 (30.4%) cases with thin pleural fluid and ICD in 32 (69.6%) patients with frank pus. Four of fourteen children (28.5%) on serial thoracocentesis underwent ICD for failure of resolution of symptoms. Further 4 of 32 (12.5%) cases on ICD were subjected to open thoracotomy and decortication.

Conclusion: Conservative management (with either thoracentesis or tube thoracostomy) of pleural effusions or empyema thoracis with antibiotics covering S. aureus and S. pneumoniae along with ICD is safe and effective without the need for prolonged hospital stay. Surgical intervention is needed only when conservative approach fails.