Short-course modified regimen intrapleural alteplase and pulmozyme (DNase) in pleural infection

Abstract

Pleural infection is a common clinical condition leading to hospitalisation. In the last decade, advances in pleural research have led to a paradigm shift in the treatment of complex effusion from a surgical approach to a less invasive non-surgical approach using a combination of intrapleural fibrinolytics and pulmozyme (DNase). We report 3 patients with pleural infection. Intercostal chest catheter failed to drain the complex effusion. They were subsequently treated with a modified short-course regimen of alteplase and DNase. They received 3 cycles of 16 mg alteplase with 5 mg DNase each within 24 hours and all three had a favourable outcome with no adverse effects. This modified regimen appears effective with good safety profile and adds to the current literature on the safety and effectiveness of different dose combinations of alteplase and DNase.

Intrapleural alteplase and DNase for complex tuberculous pleurisy: a medical approach

“…Few studies reported on the use of intrapleural urokinase or streptokinase in tuberculous effusion to facilitate pleural fluid drainage and the occurrence of residual pleural thickening [8,11,12]. There is limited literature on the use of intrapleural alteplase (with supplementary DNase) in complex tuberculous pleurisy [13,14]. Our cases showed that intrapleural alteplase and DNase facilitated more infected fluid drainage with clinical resolution of fever and dyspnoea.…”

Tuberculous empyema: combined intrapleural therapy might be an alternative

“…é reservada para pacientes com baixo risco cirúrgico, além de ser uma opção inacessível e onerosa para a grande maioria da população brasileira. (2,4) Embora bem estabelecido para o manejo do derrame pleural infectado (parapneumônico), (3)(4)(5)(6)(7) poucos estudos avaliaram a eficácia da terapia intrapleural para pacientes com diagnóstico de ET, seja com fibrinólise isoladamente ou em associação com DNase, limitados a poucas séries de casos. (5) Aqui, relatamos o caso de um paciente diagnosticado com ET com sintomas persistentes e derrame pleural, apesar do Tratamento Diretamente Observado (TDO).…”

“…No entanto, a terapia intrapleural adjuvante com alteplase e DNase por 3 dias resultou em melhora clínica, laboratorial e radiológica, associada a uma curta permanência hospitalar, sem necessidade de procedimentos cirúrgicos mais invasivos e sem efeitos adversos Não há consenso sobre a dose intrapleural a ser utilizada. (3,6) Portanto, estudos maiores precisam ser realizados para avaliar a eficácia e segurança do uso intrapleural da alteplase-DNase em ET como terapia alternativa às intervenções cirúrgicas.…”