Role of intrapleural streptokinase in empyema

Background: The intrapleural administration of fibrinolytic agents has been in use for the management of empyema. It isa safe and effective method and obviates the need for surgery in most cases. Though its efficacy is documented in Western literatures, there are only a few clinical trials reported from India. Objective: The present study was undertaken to evaluate the role of intrapleural streptokinase (STK) as an adjunctive therapy in the management of empyema. Material and methods: 45 patients of empyema were given intrapleural fibrinolytic therapy when drainage through intercostal tube was minimal, i.e., less than 30 ml/day and the tube was properly positioned and patent. Intrapleural streptokinase was administered in dosages of 2,50,000 IU in 50 ml of normal saline; and eight-hourly, radiological resolution and volume of fluid drained were assessed for final outcome. Results: A total of 45 patients were included in this study, the median doses of streptokinase used was three times in 25 (58%) and two in 20 (42%) cases. There was significant drainage of 1,000 ml+ 110 me (mean ± S.D) and radiological clearance in 30 (67%) cases. Chest pain was reported in 2, and fever in 5 patients There was no allergic reaction or bleeding in any patient. Conclusion: Intrapleural fibrinolytic therapy with streptokinase is a safe and effective adjunctive therapy in the management of empyema.