Steroid therapy and outcome of parapneumonic pleural effusions (STOPPE): Study protocol for a multicenter, double-blinded, placebo-controlled randomized clinical trial

Fitzgerald, Deirdre; Waterer, Grant; Read, Catherine; Fysh, Edward; Shrestha, Rabindra Man; Stanley, Christopher; Muruganandan, Sanjeevan; Lan, Norris S H; Popowicz, Natalia; Peddle-McIntyre, Carolyn J.; Rahman, Najib M.; Gan, Seng Khee; Murray, Kevin; Lee, Gary

doi:10.1097/md.0000000000017397

Cited by 12 publications

(9 citation statements)

References 30 publications

(28 reference statements)

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“…Shousaikoto has potential as an anti-inflammatory treatment, and has been used for pneumonia, bronchitis, lymphadenitis, and chronic hepatitis. Therefore, we hypothesized that Saireito, being a combination of Goreisan and Shousaikoto, might be effective in both edematous and inflammatory states, such as in the present case [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Saireito, a Traditional Japanese Kampo Herbal Medication, on Pacemaker-Related Pleural Effusion: A Case Report

et al. 2021

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Patient: Female, 71-year-old Final Diagnosis: Pacemaker related pleural effusion Symptoms: Dry cough Medication:— Clinical Procedure: — Specialty: Cardiology • General and Internal Medicine Objective: Unusual or unexpected effect of treatment Background: Post-cardiac injury syndrome, including pleural effusion as a delayed complication of permanent pacemaker implantation, has rarely been reported. To resolve pleural effusion, prolonged chest tube placement is often required. Anti-inflammatory agents combined with diuretics are also often prescribed. Saireito, a Japanese herbal medication, which is a combination of Goreisan and Shousaikoto, has both anti-inflammatory and water-modulation properties and has been used for edema (lymph edema, cerebral edema) and inflammation (chronic nephritis). Case Report: We describe a 71-year-old woman with a history of syncope and bradycardia who underwent dual permanent pacemaker implantation (placed in the right chest because of a persistent left superior vena cava) without complications. Two months later, she came to the hospital as an outpatient with a dry cough, and was diagnosed with right-sided pleural effusion. A pleural fluid analysis revealed exudative effusion, according to Light’s criteria. The fluid was negative for infectious etiology. Chest X-ray, computed tomography, and echocardiography revealed no signs of pericardial effusion or perforation of the pacemaker lead to outside the heart. The pleural effusion persisted despite use of anti-inflammatory medication for several weeks and diuretics for a short period. Saireito was administered with good response; the pleural effusion resolved completely and there was no deterioration of renal function. Conclusions: The present case highlights the clinical significance of Saireito as an effective therapeutic agent for late-onset pacemaker-related pleural effusion, without adverse effects such as renal dysfunction.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Saireito, a Traditional Japanese Kampo Herbal Medication, on Pacemaker-Related Pleural Effusion: A Case Report

et al. 2021

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“…Additionally, steroid therapy has been proposed as an adjunctive treatment for curbing the inflammatory response and progression of parapneumonic effusion. With that, the Steroids Therapy and Outcomes in Parapneumonic Pleural Effusions (STOPPE) trial is currently ongoing and aims to assess whether systemic steroids have a benefit in outcomes in patients with parapneumonic effusions [ 73 ]. Treatment of parapneumonic effusion with intrapleural 2% povidone-iodine solution is also an area of active research, with reported completion of a phase one trial and a phase two trial currently undergoing recruitment.…”

Section: Future Researchmentioning

confidence: 99%

Pleural Space Infections

Foley

Parrish

2023

Life

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Pleural space infections have been a well-recognized clinical syndrome for over 4000 years and continue to cause significant morbidity and mortality worldwide. However, our collective understanding of the causative pathophysiology has greatly expanded over the last few decades, as have our treatment options. The aim of this paper is to review recent updates in our understanding of this troublesome disease and to provide updates on established and emerging treatment modalities for patients suffering from pleural space infections. With that, we present a review and discussion synthesizing the recent pertinent literature surrounding the history, epidemiology, pathophysiology, diagnosis, and management of these challenging infections.

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“…Its safety in pneumonia has already been demonstrated as well as a signal towards clinical efficacy [ 124 , 125 ]. With the aim of combatting the exaggerated inflammatory cascade seen in pleural infection, the ‘Steroid therapy and outcome of parapneumonic pleural effusions’ (STOPPE) trial (ACTRN 12618000947202), is currently recruiting patients into a pilot multi-centre RCT, comparing 48 h of intravenous dexamethasone to placebo [ 126 ].…”

Section: Alternative Therapies and Future Directionsmentioning

confidence: 99%

Management of Pleural Infection

2020

Self Cite

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Pleural infection is a millennia-spanning condition that has proved challenging to treat over many years. Fourteen percent of cases of pneumonia are reported to present with a pleural effusion on chest X-ray (CXR), which rises to 44% on ultrasound but many will resolve with prompt antibiotic therapy. To guide treatment, parapneumonic effusions have been separated into distinct categories according to their biochemical, microbiological and radiological characteristics. There is wide variation in causative organisms according to geographical location and healthcare setting. Positive cultures are only obtained in 56% of cases; therefore, empirical antibiotics should provide Gram-positive, Gram-negative and anaerobic cover whilst providing adequate pleural penetrance. With the advent of next-generation sequencing techniques, yields are expected to improve. Complicated parapneumonic effusions and empyema necessitate prompt tube thoracostomy. It is reported that 16–27% treated in this way will fail on this therapy and require some form of escalation. The now seminal Multi-centre Intrapleural Sepsis Trials (MIST) demonstrated the use of combination fibrinolysin and DNase as more effective in the treatment of empyema compared to either agent alone or placebo, and success rates of 90% are reported with this technique. The focus is now on dose adjustments according to the patient’s specific ‘fibrinolytic potential’, in order to deliver personalised therapy. Surgery has remained a cornerstone in the management of pleural infection and is certainly required in late-stage manifestations of the disease. However, its role in early-stage disease and optimal patient selection is being re-explored. A number of adjunct and exploratory therapies are also discussed in this review, including the use of local anaesthetic thoracoscopy, indwelling pleural catheters, intrapleural antibiotics, pleural irrigation and steroid therapy.

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Steroid therapy and outcome of parapneumonic pleural effusions (STOPPE): Study protocol for a multicenter, double-blinded, placebo-controlled randomized clinical trial

Cited by 12 publications

References 30 publications

Effectiveness of Saireito, a Traditional Japanese Kampo Herbal Medication, on Pacemaker-Related Pleural Effusion: A Case Report

Effectiveness of Saireito, a Traditional Japanese Kampo Herbal Medication, on Pacemaker-Related Pleural Effusion: A Case Report

Pleural Space Infections

Management of Pleural Infection

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