In Dogs With Pyothorax Does Medical Management Alone, Invasive Medical Management, or Surgical Management Result in Better Long-term Outcome?

Barnaby Luke Dean,Sophie Adamantos

doi:10.18849/ve.v2i2.87

Abstract

Clinical bottom line:Currently available literature on canine pyothorax management is low quality, so it is difficult to draw meaningful conclusions from it. With this in mind, however, the literature does suggest that invasive medical management (thoracic drainage and lavage via in-dwelling thoracostomy tubes, and antimicrobial therapy) and surgical management (in conjunction with antimicrobial therapy) of canine pyothorax provide better long-term survival rates compared to non-invasive medical management (antimicrobial therapy, with or without thoracocentesis) alone. More definitive conclusions cannot be made until higher quality evidence (prospective, randomised, blinded) is available on the topic. <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" />

Highlights

One dog was treated as an outpatient with antibiotics following thoracocentesis
Seven patients were in the medical treatment group, five were in the early surgery group, and seven were in the late surgery group
One-hundred percent success has been reported in a case series of 15 canine patients where a single ultrasound-guided thoracocentesis was performed, followed by antibiotic therapy for a minimum of six weeks

Summary

Summary of the evidence

Population: Nineteen dogs with pyothorax confirmed by either the presence of intracellular bacteria on cytological examination, or a positive bacterial culture of pleural fluid, that underwent medical management, early surgery (less than 48 hours following hospitalisation) or late surgery (more than 48 hours following hospitalisation). Five dogs were treated surgically (11 median sternotomies, one lateral thoracotomy). One dog was treated as an outpatient with antibiotics following thoracocentesis. Outcome studied: Overall cost of treatment, survival rate, and duration of hospitalisation. Main findings: (relevant to PICO question): Seven patients were in the medical treatment group, five were in the early surgery group, and seven were in the late surgery group. Median cost of treatment was £1933 (range £256-2386) for the medical group, £2930 (range £2549-5246) for the early surgery group, and £6059 (range £3783-7208) for the late surgery group. All patients in all patient groups survived to discharge and none had experienced recurrence of pyothorax by six months following discharge

Limitations

Findings

Methodology Section