Treatment of subdural empyema

A review of 66 cases and a survey of the literature indicates that survival rates of around 90% should now be expected from patients with subdural empyema. Factors affecting the outcome are discussed. In addition to prompt surgical treatment and appropriate antibiotic therapy, the most important step seems to be extensive craniotomy and direct removal of subdural pus, particularly from the interhemispheric fissure. Treatment through burr holes is not acceptable. In the absence of a culture of the organisms and known antibiotic sensitivities, chloramphenicol is recommended as the drug of choice.