Streptokinase for empyema

Tk, Lim; Chin, N K

doi:10.1016/s0140-6736(05)64175-x

Cited by 6 publications

(8 citation statements)

References 5 publications

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“…However, all consecutive patients were studied, and they were managed in a consistent manner in the same centre and by a small group of physicians. The three treatment protocols were instituted over consecutive epochs and the analysis completed on an "intention to treat" basis [14,22]. Moreover, the characteristics of the study groups, including frequency of distinct empyema and positive bacterial cultures were comparable (tables 1, 2 and 3).…”

Section: Discussionmentioning

confidence: 99%

“…Failure of the pleural sepsis to respond adequately (as defined in Methods) in 48±72 h however, may be an indication for more aggressive intervention [14]. Since SK itself may increase the net volume of pleural fluid, increased volume of pleural fluid drainage following adjunctive SK therapy should be interpreted with caution [25].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, intrapleural SK is relatively safe [13], inexpensive and may induce prompt resolution in some patients [12]. Thus, it may be offered as an adjunctive modality in the initial empirical treatment of pleural sepsis [14].…”

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confidence: 99%

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Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis

Tk¹,

Chin²

1999

Eur Respir J

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Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis. T.K. Lim, N.K. Chin. #ERS Journals Ltd 1999. ABSTRACT: The efficacy of three different treatment protocols was compared: 1) simple chest tube drainage (Drain); 2) adjunctive intrapleural streptokinase (IP-SK); and 3) an aggressive empirical approach incorporating SK and early surgical drainage (SK+early OP) in patients with pleural empyema and high-risk parapneumonic effusions.This was a nonrandomized, prospective, controlled time series study of 82 consecutive patients with community-acquired empyema (n=68) and high-risk parapneumonic effusions (n=14). The following three treatment protocols were administered in sequence over 6 years: 1) Drain (n=29, chest catheter drainage); 2) IP-SK (n=23, adjunctive intrapleural fibrinolysis with 250,000 U . day -1 SK); and 3) SK+early OP (n=30, early surgical drainage was offered to patients who failed to respond promptly following initial drainage plus SK).The average duration of hospital stay in the SK+early OP group was significantly shorter than in the Drain and IP-SK groups. The mortality rate was also significantly lower in the SK+early OP than the Drain groups (3 versus 24%).It was concluded that an empirical treatment strategy which combines adjunctive intrapleural fibrinolysis with early surgical intervention results in shorter hospital stays and may reduce mortality in patients with pleural sepsis. Eur Respir J 1999; 13: 514±518.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis

Tk¹,

Chin²

1999

Eur Respir J

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“…9 Various studies showed intrapleural streptokinase more useful in multiloculated empyemas if used early as 3-4 weeks after onset of illness, before empyema fluid is fully organised. 10 The success rate of over 86% was found in one study by Nissar Khan et al in 15 patients. 9 Another study showed loculated fluid, total fluid protein > 5 g/dl, WBC >20,000/ microlitre, PH<7.2, glucose<40 mg% and LDH >100 IU/L were selected for adjunctive streptokinase treatment via chest tube drain.…”

Section: Discussionmentioning

confidence: 95%

Intrapleural Streptokinase as Adjunctive Treatment in Empyema

Nepal

Maskey

2013

J Chitwan Med Coll

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Pulmonary infections with secondary pleural involvement lead to considerable morbidity and mortality. Accepted management consists of systemic antibiotics and drainage of pleural cavity, achieved either by chest tube drainage or surgery. Open thoracotomy or video-assisted thoracoscopic surgery (VATS) achieve best drainage in gross empyema or loculated effusions but are limited by operative risk, cost and local availability. Intrapleural instillation of fibrinolytic agents like streptokinase dissolves fibrinous clots and membranes to prevent fluid sequestration and hence improve drainage. We report a case of 40 years old female with loculated empyema who was treated with adjunctive installation of serial intrapleural streptokinase after ultrasound guided pigtail insertion. Significant and early improvement of the symptoms and pathophysiology were achieved.DOI: http://dx.doi.org/10.3126/jcmc.v3i3.8636 Journal of Chitwan Medical College 2013; 3(3): 31-32

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“… 27,28,30 It may be appropriate, therefore, in patients with multiloculated high‐risk parapneumonic effusions and frank empyema who fail to improve following initial antibiotic treatment and chest tube drainage, to administer two to four doses of intrapleural streptokinase (250 000 U) per dose over 36–72 h on a ‘trial and error basis’. 31,32 …”

Section: Controlled Studies Of Empyema Therapymentioning

confidence: 99%

Recent advances in the management of pleural sepsis: What is the evidence?

1999

Respirology

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The management of pleural sepsis involves early diagnosis, administration of appropriate antibiotics, recognition of poor prognostic features and timely intervention to drain the infected pleural space. Important recent advances in the management of pleural sepsis include better imaging techniques, the use of flexible image-guided drainage catheters, adjunctive intrapleural thrombolytic therapy and the introduction of interventional thoracoscopy. These advances have been augmented, in the past year, by results from prospective controlled studies comparing different therapeutic options. This review describes an evidence-based approach to the management of pleural sepsis which incorporates recent therapeutic advances.

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Streptokinase for empyema

Cited by 6 publications

References 5 publications

Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis

Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis

Intrapleural Streptokinase as Adjunctive Treatment in Empyema

Recent advances in the management of pleural sepsis: What is the evidence?

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