Intrapleural streptokinase for empyema and complicated parapneumonic effusions
Date
2004
Authors
Diacon A.H.
Theron J.
Schuurmans M.M.
Van De Wal B.W.
Bolliger C.T.
Journal Title
Journal ISSN
Volume Title
Publisher
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.
Description
Keywords
placebo, streptokinase, fibrinolytic agent, sodium chloride, adult, antibiotic therapy, article, bacterium culture, clinical trial, controlled clinical trial, controlled study, female, human, major clinical study, male, nonhuman, outcomes research, pleura effusion, pleura empyema, priority journal, pus, randomization, randomized controlled trial, thorax radiography, treatment outcome, tube, drug instillation, lavage, multimodality cancer therapy, wound drainage, Adult, Chest Tubes, Combined Modality Therapy, Drainage, Empyema, Pleural, Female, Fibrinolytic Agents, Humans, Instillation, Drug, Irrigation, Male, Pleural Effusion, Sodium Chloride, Streptokinase
Citation
American Journal of Respiratory and Critical Care Medicine
170
1
170
1