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Published ahead of print on March 24, 2004, doi:10.1164/rccm.200312-1740OC
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American Journal of Respiratory and Critical Care Medicine Vol 170. pp. 49-53, (2004)
© 2004 American Thoracic Society

Intrapleural Streptokinase for Empyema and Complicated Parapneumonic Effusions

Andreas H. Diacon, Johan Theron, Macé M. Schuurmans, Bernard W. Van de Wal and Chris T. Bolliger

Department of Internal Medicine, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa

Correspondence and requests for reprints should be addressed to Andreas H. Diacon, M.D., Department of Internal Medicine, P.O. Box 19063, 7505 Tygerberg, South Africa. E-mail: ahd{at}sun.ac.za

We conducted a single-center, randomized, placebo-controlled trial to determine whether streptokinase instillations adjunctive to chest tube drainage reduce the need for surgery and improve outcome in patients with pleural empyema. Fifty-three patients (frank pus aspirated, 81%; microbiological agent cultured, 62%; mean effusion pH, 6.6 ± 0.4) received antibiotic treatment, chest tube drainage, and once-daily pleural rinses with either normal saline or normal saline with streptokinase (250,000 IU). Nine patients were excluded for various reasons before pleural rinses were started. Streptokinase (n = 22) was instilled over 4.5 ± 2 days and saline (n = 22) was instilled over 3 ± 1.3 days. One patient in each group died during treatment. Clinical treatment success and need for referral to surgery were the main outcome measures. No difference was observed after 3 days. After 7 days, streptokinase-treated patients had a higher clinical success rate (82 vs. 48%, p = 0.01) and fewer referrals for surgery (45 vs. 9%, p = 0.02). No significant radiologic or functional differences were observed between groups during follow-up over 6 months. We conclude that intrapleural streptokinase adjunctive to chest tube drainage reduces the need for surgery and improves the clinical treatment success in patients with pleural empyema.

Key Words: fibrinolysis • pleural effusion • pleural empyema • streptokinase




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