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Intrapleural streptokinase for the treatment of childhood empyema

Man-Yau Ho1, Hsiang-Yin Chen, Yu-Hsuan Yen

  • 1Department of Pediatrics, Taipei Medical University - Wanfang Hospital, Taipei, Taiwan.

Acta Paediatrica Taiwanica = Taiwan Er Ke Yi Xue Hui Za Zhi
|February 8, 2008
PubMed

Insights

Intrapleural streptokinase instillation safely improved pediatric empyema drainage, reducing treatment duration and need for surgery. This fibrinolytic therapy offers a promising adjunctive treatment for childhood empyema.

Area of Science:

  • Pediatric Pulmonology
  • Thoracic Surgery
  • Infectious Diseases

Background:

  • Empyema is a severe pneumonia complication in children, often requiring invasive drainage.
  • Current treatment for loculated empyema involves percutaneous catheter drainage.
  • Intrapleural fibrinolytic agents can aid drainage of viscous pleural fluid.

Purpose of the Study:

  • To compare streptokinase instillation with conventional chest tube drainage for pediatric empyema.
  • To evaluate the efficacy and safety of streptokinase as an adjunctive therapy.

Main Methods:

  • Retrospective study of 21 pediatric empyema cases (1999-2005).
  • Comparison between streptokinase (SK) instillation group and conventional tube drainage (T) group.
  • Data collected on drainage volume, duration, febrile course, need for surgery, and hospitalization length.

Main Results:

  • The SK group showed significantly shorter drainage duration (8 vs. 16 days, p=0.02).
  • Fewer patients in the SK group required video-assisted thoracoscopic surgery (VATS) compared to the T group (0 vs. 5).
  • Hospitalization was shorter in the SK group (21.5 vs. 24 days).

Conclusions:

  • Intrapleural streptokinase is a safe adjunctive therapy for pediatric empyema, facilitating drainage.
  • Streptokinase instillation may reduce the need for VATS and shorten hospital stays.
  • Further research is needed to compare fibrinolytic agents with VATS as primary treatment.
Abstract

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