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.
Bach, J.F. Balakrishnan, A. (2015) Retrospective comparison of the costs between medical and surgical treatment of canine pyothorax. Canadian Veterinary Journal, 56 (11) pp. 1140-1143.
Boothe, H.W. et al. (2010) Evaluation of outcomes in dogs treated for pyothorax: 46 cases (1983-2001). Journal of the American Veterinary Medical Association, 236 (6), pp. 657-663. http://dx.doi.org/10.2460/javma.236.6.657
Demetriou, J.L. et al. (2002) Canine and feline pyothorax: a retrospective study of 50 cases in the UK and Ireland. Journal of Small Animal Practice; 43 (9) pp. 388-394.
Frendin, J. (1997) Pyogranulomatous pleuritis with empyema in hunting dogs. Zentralbl Veterinarmed A, 44 (3), pp. 167-178. http://dx.doi.org/10.1111/j.1439-0442.1997.tb01098.x
Johnson, M.S. Martin, M.W.S (2006) Successful medical treatment of 15 dogs with pyothorax. Journal of Small Animal Practice, 48 (1), pp. 12-16.
Lee, K.C.L (2014) Surgical or medical management of pyothorax in dogs? Veterinary Record, 174 (24), pp. 605-606. http://dx.doi.org/10.1136/vr.g3817
MacPhail, C.M (2007) Medical and Surgical Management of Pyothorax. Veterinary Clinics of North America, 37 (5), pp. 975-988. http://dx.doi.org/10.1016/j.cvsm.2007.05.012
Meakin, L.B. et al. (2013) Prevalence, outcome and risk factors for postoperative pyothorax in 232 dogs undergoing thoracic surgery. Journal of Small Animal Practice, 54 (6) pp. 313-317. http://dx.doi.org/10.1111/jsap.12064
Mellanby, R.J. Villiers, E. Herrtage, M.E. (2002) Canine pleural and mediastinal effusions: a retrospective study of 81 cases. Journal of Small Animal Practice, 43 pp. 447-451.
Piek, C.J. Robben, J.H. (2000) Pyothorax in nine dogs. The Veterinary Quarterly, 22 (2), pp. 107-111. http://dx.doi.org/10.1080/01652176.2000.9695035
Robertson, S.A. et al. (1983) Thoracic empyema in the dog: a report of twenty-two cases. Journal of Small Animal Practice, 24 (2), pp. 103-119. http://dx.doi.org/10.1111/j.1748-5827.1983.tb00419.x
Rooney, M.B. Monnet, E. (2002) Medical and surgical treatment of pyothorax in dogs: 26 cases (1991-2001). Journal of the American Veterinary Medical Association, 221 (1), pp. 86-92.
Stillion, J.R. Letendre, J.A. (2015) A clinical review of the pathophysiology, diagnosis, and treatment of pyothorax in dogs and cats. Journal of Veterinary Emergency and Critical Care, 25 (1), pp. 113-129.
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