Evaluation of a pediatric protocol of intrapleural urokinase for pleural empyema: A prospective study

Parapneumonic Effusion in Children

“…Stefanutti et al 73 also supported the use of UK and their study showed that intrapleural UK has been shown to be effective in the treatment of PPE in children.…”

“…Streptokinase has same mechanism of action of UK; however, it is of bacterial origin rather than a recombinant human enzyme. 73 The recommended dose is 25 000 IU/kg in 50 to 100 mL in saline intrapleurally via a chest tube with clamping for 4 hours; a total dose of 250 000 IU per instillation should be never exceeded. 69 A study published by Yao et al 65 showed that intrapleural fibrinolytic treatment with streptokinase is safe and effective and it can avert the need for surgery in most cases; safety was measured by the lack of major side effects after streptokinase instillation while efficacy was measured by pleural fluid drainage of 4-fold higher compared to the control group.…”

“…62 Urokinase is preferred over streptokinase because of its lower allergenic risk, but it is more expensive. 73 UK and tPA were compared in a retrospective review study that included 71 children with PPE. The study concluded that primary management achievement was 98% for alteplase and 100% for UK, with no reported major complications.…”

Infection in pediatric interventional radiology

“…Fibrinolytic agents break fibrous strands, and clear lymphatic pores for fluid resorption [27]. Tissue plasminogen activator (rt-PA), urokinase and streptokinase have all been described, although streptokinase is rarely used due to concerns of anaphylaxis [10,11,28,29]. These agents are injected directly into the pleural space via the catheter, which is then clamped for approximately 1 h prior to replacing the suction tube.…”

“…Described dosing protocols for rt-PA are 2 mg in 20 ml normal saline twice a day or 0.1 mg/kg up to 4 mg in 20 ml three times a day [10,11]. For urokinase, described dosing includes 3100 u/kg/day (administered as 1000 u/ml and a maximum dose of 100 ml) and 56,000 u/m 2 (also administered as 1000 u/ml) [28,29]. The pleural space is cleared of fluid and septations within the first few days, and drainage is continued until the tube output decreases.…”