Forster J, Piazza G, Goettler D, et al. - In the present study, the researchers sought to analyze prehospital antibiotic therapy (PH-ABT) of children with parapneumonic pleural effusion and pleural empyema (PPE/PE) and examine its impacts on clinical outcome and pathogen detection. Between October 2010 and June 2018, prospective nationwide active surveillance in Germany. Children and adolescents < 18 years of age with drainage-requiring PE or PPE associated with pneumonia or with PPE/PE persistence > 7 days were involved. In total, 1,724 children with PPE/PE were reported, of whom 556 children (32.3% of 1719 with available data) received PH-ABT. PH-ABT substantially decreased the overall rate of culture-based bacterial pathogen detection in children with PPE/PE, but not by polymerase chain reaction. A lower rate of infectious complications was associated with PH-ABT, but it did not affect the overall duration of the disease. Therefore, the authors speculate that the duration of PPE/PE is mainly a consequence of an infection-induced inflammatory process, which can only partially be affected by antibiotic treatment.