Making recommendations with regard to the treatment of diseases that occur infrequently is difficult. By the time enough experience is gained in the management of a rare disease, technology or chemotherapy previously used is likely to be obsolete. For infectious diseases, not only do therapeutic measures change, but the causative pathogens and their susceptibility to antibiotics evolve as well. For example, in the preantibiotic era childhood empyema was frequently a complication of Streptococcus pneumoniae pneumonia.1 After the introduction of penicillin, Staphylococcus aureus was most commonly isolated, and now, with many effective antistaphylococcal antibiotics available, the incidence of empyema is low and caused equally by S aureus, S pneumoniae, and Streptococcus pyogenes (T. Chonmaitree, MD, K.R.P., unpublished data, June 1981).
Primary pulmonary abscesses have never been common in children, and the documentation of causative pathogens has been sparse. In 1904, Holt reported two cases of lung abscess after pneumonia.2