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Controlled trial of intrapleural streptokinase in the treatment of pleural empyema and complicated parapneumonic effusions.

AbstractOBJECTIVE:
To compare the efficacy of adjunctive intrapleural streptokinase (SK) with simple closed chest tube drainage (Drain) in the treatment of empyemas and complicated parapneumonic effusions.
METHOD:
This was a controlled study of 52 patients (mean age, 57 years; 41 men) with pleura space sepsis. Forty patients (77%) had empyema and 12 had complicated parapneumonic effusions. Twenty-nine patients were treated with Drain only while 23 received, in addition, repeated daily SK, 250,000 U in saline solution (mean, 5.3 days).
RESULTS:
The two groups of patients had comparable degrees of peripheral blood leukocytosis, frequency of loculated effusions, pleural fluid pH, and lactate dehydrogenase levels. Infective organisms were isolated in 54% of which 32% were anaerobic and 21% were polymicrobial infections. The incidence of surgical decortication was 17% and mortality was 15%. A significantly larger volume of pleural fluid was drained from patients in the SK treatment group (2.0 [1.5] L) than those in the Drain treatment group (1.0 [1.01] L). There were no significant differences, however, between the two treatment groups in terms of duration before defervescence, duration of hospital stay, the need for surgical intervention, or mortality rates.
CONCLUSION:
We conclude that thrombolytic therapy increased the volume of fluid drained from pleural empyemas but did not markedly reduce morbidity and mortality.
AuthorsN K Chin, T K Lim
JournalChest (Chest) Vol. 111 Issue 2 Pg. 275-9 (Feb 1997) ISSN: 0012-3692 [Print] United States
PMID9041968 (Publication Type: Clinical Trial, Comparative Study, Controlled Clinical Trial, Journal Article)
Chemical References
  • Fibrinolytic Agents
  • Streptokinase
Topics
  • Adult
  • Drainage
  • Empyema, Pleural (drug therapy, therapy)
  • Female
  • Fibrinolytic Agents (therapeutic use)
  • Humans
  • Male
  • Middle Aged
  • Pleural Effusion (drug therapy, therapy)
  • Streptokinase (therapeutic use)
  • Treatment Outcome

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