help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Published ahead of print on March 24, 2004, doi:10.1164/rccm.200312-1740OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 1, July 2004, 49-53

A more recent version of this article appeared on July 1, 2004
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
200312-1740OCv1
170/1/49    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Diacon, A. H
Right arrow Articles by Bolliger, C. T
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Diacon, A. H
Right arrow Articles by Bolliger, C. T

Submitted on December 19, 2003
Accepted on March 22, 2004

Intrapleural Streptokinase for Empyema and Complicated Parapneumonic Effusions

Andreas H Diacon1*, Johan Theron1, Mace M Schuurmans1, Bernard W Van de Wal1, and Chris T Bolliger1

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

* To whom correspondence should be addressed. 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 (250000 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) 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 three days. After seven days, streptokinase treated patients had a higher clinical success rate (82% vs 48%, p=0.01) and fewer referrals for surgery (43% vs 9%, p=0.02). No significant radiological or functional differences were observed between groups during follow-up over six 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: Pleural empyema, streptokinase, fibrinolysis, pleural effusion




This article has been cited by other articles:


Home page
 ChestHome page
J. E. Heffner, J. S. Klein, and C. Hampson
Interventional Management of Pleural Infections
Chest, October 1, 2009; 136(4): 1148 - 1159.
[Abstract] [Full Text] [PDF]

Home page
 Journal of Pharmacy PracticeHome page
C. R. Emerson, C. M. Bercume, M. S. Antonopoulos, and N. Marzella
The Administration of rt-PA (Activase(R)) for the Treatment of Empyema in an Adult Patient
Journal of Pharmacy Practice, February 1, 2009; 22(1): 117 - 123.
[Abstract] [PDF]

Home page
 StrokeHome page
M. Menendez-Gonzalez, P. Oliva-Nacarino, and A. Alvarez-Cofino
Cerebral Gas Embolism Caused by Pleural Fibrinolytic Treatment
Stroke, September 1, 2007; 38(9): 2602 - 2604.
[Abstract] [Full Text] [PDF]

Home page
 Mayo Clin Proc.Home page
G. M. Levinson and D. W. Pennington
Intrapleural Fibrinolytics Combined With Image-Guided Chest Tube Drainage for Pleural Infection
Mayo Clin. Proc., April 1, 2007; 82(4): 407 - 413.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
J. E. Heffner
Update in pulmonary medicine.
Ann Intern Med, November 21, 2006; 145(10): 765 - 773.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
G. F. Tassi, R. J. O. Davies, and M. Noppen
Advanced techniques in medical thoracoscopy.
Eur. Respir. J., November 1, 2006; 28(5): 1051 - 1059.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
Z. Zhu, M. L. Hawthorne, Y. Guo, W. Drake, S. Bilaceroglu, H. L. Misra, and R. W. Light
Tissue Plasminogen Activator Combined With Human Recombinant Deoxyribonuclease Is Effective Therapy for Empyema in a Rabbit Model
Chest, June 1, 2006; 129(6): 1577 - 1583.
[Abstract] [Full Text] [PDF]

Home page
 DTBHome page
Managing empyema in adults
DTB, March 1, 2006; 44(3): 17 - 21.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
Y. Tokuda, D. Matsushima, G. H. Stein, and S. Miyagi
Intrapleural Fibrinolytic Agents for Empyema and Complicated Parapneumonic Effusions: A Meta-analysis
Chest, March 1, 2006; 129(3): 783 - 790.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
R. W. Light
Parapneumonic effusions and empyema.
Proceedings of the ATS, January 1, 2006; 3(1): 75 - 80.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
G. Cheng and J. R.E. Vintch
A Retrospective Analysis of the Management of Parapneumonic Empyemas in a County Teaching Facility From 1992 to 2004
Chest, November 1, 2005; 128(5): 3284 - 3290.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
M. H. Brutsche, G.-F. Tassi, S. Gyorik, M. Gokcimen, C. Renard, G. P. Marchetti, and J.-M. Tschopp
Treatment of Sonographically Stratified Multiloculated Thoracic Empyema by Medical Thoracoscopy
Chest, November 1, 2005; 128(5): 3303 - 3309.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
C. K. Katikireddy, D. S. Dube, A. H. Diacon, C. F.N. Koegelenberg, C. T. Bolliger, U. W. Rosa, D. Bouros, R. J.O. Davies, N. A. Maskell, and A. J. Nunn
A Trial of Intrapleural Streptokinase
N. Engl. J. Med., May 26, 2005; 352(21): 2243 - 2245.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
B. Nemery, W. W. Yew, R. Albert, C. Brun-Buisson, W. MacNee, F. J. Martinez, D. C. Angus, and E. Abraham
Tuberculosis, Nontuberculous Lung Infection, Pleural Disorders, Pulmonary Function, Respiratory Muscles, Occupational Lung Disease, Pulmonary Infections, and Social Issues in AJRCCM in 2004
Am. J. Respir. Crit. Care Med., March 15, 2005; 171(6): 554 - 562.
[Full Text] [PDF]

Home page
 NEJMHome page
N. A. Maskell, C. W.H. Davies, A. J. Nunn, E. L. Hedley, F. V. Gleeson, R. Miller, R. Gabe, G. L. Rees, T. E.A. Peto, M. A. Woodhead, et al.
U.K. Controlled Trial of Intrapleural Streptokinase for Pleural Infection
N. Engl. J. Med., March 3, 2005; 352(9): 865 - 874.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
J. E. Heffner
Multicenter Trials of Treatment for Empyema -- After All These Years
N. Engl. J. Med., March 3, 2005; 352(9): 926 - 928.
[Full Text] [PDF]

Home page
 JWatch Infect. DiseasesHome page
Intrapleural Streptokinase for Empyema
Journal Watch Infectious Diseases, July 26, 2004; 2004(726): 8 - 8.
[Full Text]

Home page
 Am. J. Respir. Crit. Care Med.Home page
Y. C. G. Lee
Ongoing Search for Effective Intrapleural Therapy for Empyema: Is Streptokinase the Answer?
Am. J. Respir. Crit. Care Med., July 1, 2004; 170(1): 1 - 2.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2004 American Thoracic Society 		  CCM abstracts