Bacterial pneumonia complicated with pleuritis and empyema is very serious which causes substantial morbidity and mortality. Currently, in addition to appropriate use of antibiotic, drainage of the fluid or pus is the mainstay therapy. However, in many instances percutaneous catheter drainage is insufficient particularly in cases with loculated empyema. More aggressive methods to facilitate the evacuation of the empyema are often required. Currently, either intrapleural instillation of fibrinolytic agent or video-assisted thoracoscopic surgery are considered as effective and safe to facilitate drainage. Further, prospective well design studies to compare the two methods as the direct initial step treatment are needed.