Abstract          Objectives: To evaluate different modalities of treatment in empyema chest in children in respect to different stages of disease. Methods: 94 patients in age group 1 to 12 years admitted in department of surgery, Government Medical College, Miraj with diagnosis empyema chest managed by various treatment options according to stage of disease. Results: 63 patients shows improvement after intercostal drainage. Mean hospital stay was 7 days. 6 patients managed by streptokinase instillation through inter costal drain. Mean hospital stay was 11.89 days and decision thoracotomy was taken in 25 patients and mean hospital stay was 25.48 days. Conclusion: Management of pleural empyema in childrens depend on time of presentation. Early presentation improved by ICD and antibiotics only and surgical indica­tion is often delayed, particularly when there is late presentation causing multiple loculations or severe sepsis. Early thoracotomy yields a better clinical outcome for pediatric patients with pleural empyema, with apparent decreased morbidity and mortality, earlier chest tube removal, earlier hospital discharge and improved response to antibiotic therapy.

Keywords: Empyema; children; thoracotomy;