Chest
Controlled Trial of Intrapleural Streptokinase in the Treatment of Pleural Empyema and Complicated Parapneumonic Effusions
Section snippets
Materials and Methods
This was a 5-year (1990 to 1995), prospective study of 52 consecutive patients admitted to the hospital with community-acquired empyema and complicated (high-risk) parapneumonic effusions.17 Empyema (40 patients) was defined according to one or more of the following criteria; (1) grossly purulent fluid; (2) positive fluid culture; and (3) positive Gram stain for bacteria.1 Complicated parapneumonic effusions (12 patients) were defined according to Light1 viz (1) pH <7.00 or (2) lactate
Results
There were 52 patients (41 men and 11 women) with a mean (SD) age of 57 (17) years, range between 16 and 18 years. Most patients (75%) had some underlying disease, with diabetes in 41% and chronic lung diseases in 31%. There were no significant differences in age, sex ratio, frequency of underlying disease, and degrees of peripheral blood leukocytosis between patients on the SK and Drain treatment protocols (Table 1).
Forty patients (77%) had frank empyema and the rest had complicated
Discussion
Previous reports on the use of intrapleural thrombolysis as an adjunctive modality in the treatment of empyema suggested that it may be highly effective with success rates ranging from about 50 to 100%.8, 9, 10, 11, 12, 13, 14, 15, 16 These include a multicenter report of 30 patients from Mexico by Jerjes-Sanchez et al16 (SK was used) and a large series of 84 patients with multiloculated effusions from Denver described by Moulton et al15 (urokinase was used). The overall success rate of 70% (SK
References (25)
Empyema thoracis: factors influencing morbidity and mortality
Chest
(1991)Management of acute empyema
Chest
(1992)- et al.
Empyema thoracis: therapeutic management and outcome
Chest
(1995) - et al.
The sun should never set on a parapneumonic effusion
Chest
(1989) - et al.
Use of purified streptokinase in the treatment of empyema and hemothorax
Am J Surg
(1991) - et al.
Intrapleural fibrinolytic treatment of multiloculated thoracic empyemas
Ann Thorac Surg
(1994) - et al.
Treatment of complicated pleural fluid collections with image-guided drainage and intracavitary urokinase
Chest
(1995) - et al.
Intrapleural fibrinolysis with streptokinase as an adjunctive treatment in hemothorax and empyema: a multi-center trial
Chest
(1996) - et al.
Thoracoscopic debridement and pleura irrigation in the management of empyema thoracis
Ann Thorac Surg
(1991) - et al.
Thoracoscopy for empyema and hemothorax
Chest
(1996)
Pleural diseases
The clinical course and management of thoracic empyema
Q J Med
Cited by (152)
Pleural Infection
2021, Encyclopedia of Respiratory Medicine, Second EditionImaging guided streptokinase injected through small bore pigtail tail catheter in management of complicated empyema in pediatrics
2017, Egyptian Journal of Radiology and Nuclear MedicineNew therapy of pleural empyema by deoxyribonuclease
2013, Brazilian Journal of Infectious DiseasesCitation Excerpt :Some authors suggest that intrapleural instillation of fibrinolytic agents appears to be an effective and less invasive alternative to surgical treatment.3–6 The results of some control studies using purified streptokinase are divergent.7,8 Simpson et al. suggest that purified streptokinase was less effective than the older drug preparation which has contained a small proportion of streptococcal DNase.2,9
Intrapleural administration of Pulmozyme for pleural empyema
2011, Respiratory Medicine CMEManagement of pleural infection in adults: British Thoracic Society pleural disease guideline 2010
2010, ThoraxCitation Excerpt :There is a report of adult respiratory distress syndrome in a patient who received both streptokinase and urokinase for empyema drainage.182 Doses of fibrinolytics used in studies have varied but include streptokinase 250 000 IU daily11 145 147–149 151–157 160 163 165 167 169 170 173–176 179 or 250 000 IU 12-hourly84 151 or urokinase 100 000 IU daily170 171 178 retained for 2–4 h in the pleural space. There is currently interest in other intrapleural agents including combination therapy with fibrinolytics and fluid viscosity and biofilm-disrupting agents such as streptodornase and deoxyribonuclease (DNase).183 184