Respiratorymiddle twist
A 58-year-old man was started on oral amoxicillin five days ago for right lower lobe pneumonia. He returns because his fevers have continued and he is more breathless. His temperature is 38.7 °C. The right base is stony dull with absent breath sounds, and a chest radiograph shows a moderate right pleural effusion. A diagnostic pleural aspirate is cloudy; analysis shows pleural fluid protein 38 g/L (serum 62 g/L), pleural lactate dehydrogenase 640 U/L (serum 190 U/L; upper limit of normal 250), pleural glucose 1.9 mmol/L and pleural fluid pH 7.14. Gram stain shows no organisms.
Which one of the following is the most appropriate next step in management?