Randomized controlled trial of intrapleural streptokinase in empyema thoracis in children

Singh, Meenu; Mathew, JosephL; Chandra, SahaSubhash; Katariya, S.; Kumar, Lata

doi:10.1111/j.1651-2227.2004.tb02626.x

Cited by 63 publications

(49 citation statements)

References 7 publications

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“…However, a study in Germany considered that chest drainage fails to shorten admission time relative to thoracocentesis (46). Traditional opinions think that a large-diameter drainage tube (>24 F) is beneficial to pleural effusion drainage, while a small-diameter drainage tube (10-14 F) can also receive a similar effect (30,46,47), and can be easily accepted by these patients. Ultrasound-guided drainage tube placement technology is very practical for patients with serious diseases, empyema, encapsulated effusion and pleural thickening (8).…”

Section: Thoracocentesis and Chest Drainage Tube Placementmentioning

confidence: 99%

“…Hence, the fibrinolytic agent can be applied for improvement of drainage. A series studies also considered that the streptokinase or urokinase used in the pleural cavity can reduce hospital stay, prognosis improvement (9,(47)(48)(49)(50)(51) and prevent catastrophic hazards (4,50,52,53). However, the largest random and controlled clinical study considers that streptokinase application in the pleural cavity has failed to improve hospital stay, death rate and others, to date (22) and a researcher also considers that the fibrinolytic agent has failed to reduce fatality rate (54).…”

Section: Intrapleural Cavity Injectionmentioning

confidence: 99%

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Infectious pleural effusion status and treatment progress

Yang

Zhang

2017

J. Thorac. Dis.

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Pleural cavity infection continuously seriously threatens human health with continuous medical progress. From the perspective of pathophysiology, it can be divided into three stages: exudative stage, fibrin exudation and pus formation stage, and organization stage. Due to the pathogenic bacteria difference of pleural cavity infection and pulmonary infection, it is very important for disease treatment to analyze the bacteria and biochemical characteristics of the infectious pleural effusion. Most prognoses of patients have been relatively good, while for some patients, the complicated parapneumonic effusion or empyema could be evolved. Antibiotic treatment and sufficient drainage are the foundation for this treatment. No evidence can support the routine use of a fibrin agent. However, it has been reported that the plasminogen activator and deoxyribonuclease can be recommended to be applied in the pleural cavity. In case of failure on conservative medical treatment, operative treatment can be applied such as thoracoscopy and pleural decortication.According to the clinical characteristics of these patients, it is a key to research prognosis, as well as early evaluation and stratification, in the future.

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Section: Thoracocentesis and Chest Drainage Tube Placementmentioning

confidence: 99%

Section: Intrapleural Cavity Injectionmentioning

confidence: 99%

Infectious pleural effusion status and treatment progress

Yang

Zhang

2017

J. Thorac. Dis.

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“…[19,20] Other prospective studies comparing fibrinolysis with normal saline or various doses of urokinase report fibrinolysis failure rates of 7 -24%. [7,8,21] A meta-analysis published in 2005 calculated the average failure rate of 64 empyema cases treated with primary fibrinolysis to be 9.3%. [15] …”

Section: Discussionmentioning

confidence: 99%

“…In a study in the UK, Thomson et al [7] reported that urokinase resulted in a 2-day reduction in length of hospital stay compared with normal saline, but the rate of treatment failure was similar in both treatment groups. Singh et al [8] compared streptokinase with normal saline and reported that the need for surgical decortication was higher at 30 days in the normal-saline groups. Intrapleural fibrinolysis as the primary intervention for empyema has an outcome equivalent to videoassisted thorascopic surgery (VATS).…”

mentioning

confidence: 99%

Impact of fibrinolytics on the outcome of empyema in South African children

et al. 2015

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“…In a randomised controlled trial of urokinase versus placebo, the primary outcome measure was length of hospital stay postintervention and was significantly in favour of urokinase (7.4 versus 9.5 days) [182]. In contrast, a randomised controlled trial of streptokinase versus placebo found no difference in clinical and sonographic outcome [183]. A randomised comparison of urokinase versus video-assisted thoracosopic surgery (VATS) found no difference in clinical outcome but showed that urokinase was a more economic treatment option [184].…”

Section: Pleural Infection In Children Evidence Basementioning

confidence: 99%

Respiratory medicines for children: current evidence, unlicensed use and research priorities

Smyth¹,

Barbato²,

Beydon³

et al. 2009

Eur Respir J

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This European Respiratory Society task force has reviewed the evidence for paediatric medicines in respiratory disease occurring in adults and children. We describe offlicence use, research priorities and ongoing studies.Off-licence and off-label prescribing in children is widespread and potentially harmful. Research areas in asthma include novel formulations and regimens, and individualised prescribing. In cystic fibrosis, future studies will focus on screened infants and robust outcome measures are needed. Other areas include new enzyme and antibiotic formulations and the basic defect. Research into pneumonia should include evaluation of new antibacterials and regimens, rapid diagnostic tests and, in pleural infection, antibiotic penetration, fibrinolytics and surveillance. In uncommon conditions, such as primary ciliary dyskinesia, congenital pulmonary abnormalities or neuromuscular disorders, drugs indicated for other conditions (e.g. dornase alfa) are commonly used and trials are needed. In neuromuscular disorders, the b-agonists may enhance muscle strength and are in need of evaluation. Studies of antibiotic prophylaxis, immunoglobulin and antifungal drugs are needed in immune deficiency.We hope that this summary of the evidence for respiratory medicines in children, highlighting gaps and research priorities, will be useful for the pharmaceutical industry, the paediatric committee of the European Medicines Agency, academic investigators and the lay public.

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Randomized controlled trial of intrapleural streptokinase in empyema thoracis in children

Abstract: There is no short-term clinical benefit of intrapleural streptokinase in paediatric empyema; this therapy may be reserved for those with stage 7 empyema to prevent pleural thickening in the long term.

Cited by 63 publications

References 7 publications

Infectious pleural effusion status and treatment progress

Infectious pleural effusion status and treatment progress

Impact of fibrinolytics on the outcome of empyema in South African children

Respiratory medicines for children: current evidence, unlicensed use and research priorities

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