Abstract |
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.
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Authors | Andreas H Diacon, Johan Theron, Macé M Schuurmans, Bernard W Van de Wal, Chris T Bolliger |
Journal | American journal of respiratory and critical care medicine
(Am J Respir Crit Care Med)
Vol. 170
Issue 1
Pg. 49-53
(Jul 01 2004)
ISSN: 1073-449X [Print] United States |
PMID | 15044206
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Fibrinolytic Agents
- Sodium Chloride
- Streptokinase
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Topics |
- Adult
- Chest Tubes
- Combined Modality Therapy
- Drainage
- Empyema, Pleural
(drug therapy, therapy)
- Female
- Fibrinolytic Agents
(administration & dosage)
- Humans
- Instillation, Drug
- Male
- Pleural Effusion
(drug therapy, therapy)
- Sodium Chloride
(administration & dosage)
- Streptokinase
(administration & dosage)
- Therapeutic Irrigation
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