Intrapleural streptokinase in complicated parapneumonic effusions and empyema.

BACKGROUND: The management of complicated parapneumonic effusions (CPE) and empyema by chest tube drainage usually fails because of thick viscous fluid and multiple pleural space loculations. The use of intrapleural fibrinolytic agents facilitates pleural drainage and can obviate the need for more invasive surgical interventions in these types of effusions.

OBJECTIVE: To evaluate the role of intrapleural fibrinolytic therapy with streptokinase (STK) as an adjunctive therapy in the management of CPE and empyema.

MATERIAL AND METHODS: Thirty patients of CPE and empyema were considered for intrapleural fibrinolytic therapy when the chest tubes/catheter drainage became insignificant (i.e., less than 50 ml a day) and the tube was adequately positioned and patent. Intrapleural STK was administered eight hourly in the dosage of 2,50,000 IU in 50 ml of saline. The end points were volume of fluid drained and radiological resolution.

RESULTS: [corrected] There were 24 (80%) patients with CPE and six (20%) with empyema, with a mean age of 35 years. The median of STK doses used were three in 26 (87%) cases and two in four (13%) cases. There was significant drainage (mean +/- SD) 1094 ml +/- 116 and radiological resolution in 26 (87%) cases. The only complication observed was transient chest pain in one and fever in two patients.

CONCLUSION: Intrapleural fibrinolytic therapy with STK is a safe and effective adjunctive therapy in the management of CPE and empyema.