i got a patient admitted 5 days ago. He is 12 years old and his weight on admission was 22.4kg. After 2day his weight went down to 19kg. He had cough, SOB, palpitation for a month. He had made several visits to doctors and had been treated with oral antibiotics as an outpatient. But there was no improvement . We had a chest XRAY done and there was massive effusion,which was confirmed with a chest CT and USS. Then we started looking for the cause. TB screening was done during 1st day of admission and it was negative. We had a pleural fluid analysis done and high protein ,cytology showed an inflammatory process. But PCR had not yet been done by the managment till the 2nd say after admission. Ampiclox ,Ceftrixone,Voncamycin,Gentamicn,Cefotaxime were precribed and eventually antituberculous management was started on empirical basis with no solid evidance, which was about a week ago. Also a chest tube is put, which drained around 3litres on the 1st day. However the patient is deteriorating : dyspenic , LOA,LOW ,oxygen dependant and cachexic. Chest xray is the same. Kindly help me and tell me what I should do?