Comparison of Six versus Three Doses of Intrapleural Fibrinolytic Therapy in Children with Empyema: A Randomized...

Area of Science:

• Pediatric Pulmonology
• Infectious Diseases
• Thoracic Surgery

Background:

• Empyema is a significant thoracic infection in children.
• Intrapleural streptokinase (SK) is a treatment option for pediatric empyema.
• Optimizing SK dosage is crucial for treatment efficacy.

Purpose of the Study:

• To compare the efficacy and safety of six doses versus three doses of intrapleural streptokinase (SK) in children diagnosed with empyema.
• To evaluate key clinical outcomes including treatment failure, fluid drainage, symptom duration, and hospitalization length.

Main Methods:

• A randomized controlled trial was conducted involving children with empyema.
• Participants received either six doses (twice daily for 3 days) or three doses (once daily for 3 days) of intrapleural streptokinase.
• Outcomes assessed included treatment failure, fluid drained, duration of fever and respiratory distress, hospitalization, need for surgery, adverse events, and cost.

Main Results:

• Six doses of SK resulted in significantly higher cumulative pleural pus drainage (p=0.02).
• Shorter durations of fever (p=0.04) and respiratory distress (p=0.03) were observed with the six-dose regimen.
• No significant differences were found in hospitalization length, need for surgical decortication, or treatment failure rates between the groups.

Conclusions:

• Six doses of intrapleural streptokinase appear superior to the conventional three doses for treating pediatric empyema.
• The six-dose regimen offers comparable safety and cost to the three-dose regimen.
• This suggests an optimized dosing strategy for intrapleural streptokinase in pediatric empyema management.