Intrapleural streptokinase is effective and safe for children with multi‐loculated empyema regardless of the time from disease onset

Abstract

Intrapleural streptokinase was effective for multi-loculated empyema even when it was administered more than 14 days after disease onset and four to six doses were superior to three doses.

Intrapleural Fibrinolytic Therapy in Empyema Thoracis: Where are we now and where do we go from here?

“…Children in this study had symptoms for 2-3 wk prior to presentation. Although it does not suggest that empyema was present for the same duration, it indirectly confirms our findings that fibrinolytics can work even beyond the traditional time limit of 7-10 d [8]. Unfortunately, more careful analysis of the duration is hampered because the authors presented data using medians (in the tables) and means (in the text).…”

“…The authors also did not describe the criteria for removal of chest tube drains, definition of treatment failure, criteria for surgical referral, time lag between referral and surgery, postsurgical morbidity & hospitalization, etc. We have previously observed that children undergoing surgery have longer duration of hospitalization and intercostal drainage [8]. In this study, it is unclear whether the statistically significant and clinically impressive differences (in the mean durations of hospitalization and intercostal drainage) were because 9/44 (20.5%) children in the non-urokinase group underwent surgery, compared to 4/10 (10%) among those who received it.…”

“…Medical units often use fibrinolytics, whereas Surgical units proceed with drainage and/or decortication. Our institution has been a pioneer in the systematic evaluation and usage of intrapleural streptokinase in empyema [7] and we recently confirmed its efficacy in loculated empyema, even when administered late i.e., beyond 14 d after disease onset (when it is not expected to work) [8]. Further, we found that 4-6 doses could be superior to the conventional 3 doses, although there was inadequate power to confirm this.…”

Pleural empyema in children - benefits of primary thoracoscopic treatment.

“…Use of nonoperative alternatives is connected with increased morbidity and mortality [21]. Fibrinolysis is seldom a one-stage procedure [22]. A nationwide surveillance study from Germany revealed that a third of those initially treated with noninvasive therapy required secondary, invasive treatment [23].…”

Management of Complicated Pneumonia in Children: Evidence Beyond Guidelines

“…The drainage effusion amount should be monitored and recorded daily, with recommended therapy ranging from 3 to 5 days. The success rate with streptokinase is 70%-90%, usually in three doses but up to 6 doses can be helpful [86][87][88][89][90].…”