Intrapleural streptokinase for the treatment of childhood empyema

Man Yau Ho, Hsiang Yin Chen, Yu Hsuan Yen, Yao Shun Yang, Shao Hung Lien

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Pleuritis with empyema is a serious complication of bacterial pneumonia, which often causes substantial morbidity and mortality among pediatric patients. Currently percutaneous catheter drainage is the mainstay therapy for loculated empyema. Intrapleural instillation of streptokinase, urokinase, and recombinant tissue plasminogen activator has been reported to facilitate the drainage of viscous fluid and fibrinous debris or multiple loculations from the pleural space of such patients. Methods: In this study, we compared with the treatments of pleural empyema by instillation of streptokinase through the chest tube and using the conventional chest tube drainage alone. Results: We collected 21 cases from 1999 through 2005. The results of the study showed that streptokinase (SK) group patients revealed a larger volume of drainage in the beginning days of the instillation and required fewer days of drainage than tube drainage (T) group patients [8 (4.5 - 10) days vs. 16 (5.8 - 20.3) days, p = 0.02]; that the SK group patients required average 2.6 instillations. The SK patients had a shorter febrile course than the T group [12.5 (9.5 - 15.5) days vs. 16 (9.5 - 22.5) days, p = 0.14]. None of the SK patients needed additional video-assisted thoracoscope surgery (VATS) whereas 5 patients in the T group did. The length of hospitalization in the SK group was 21.5 days and the T group patients was 24 days. Conclusions: Intrapleural instillation of streptokinase seldom caused clinical adverse effect and appears to be a safe adjunctive therapy to facilitate the drainage of empyema in pediatric patients. Further studies with better research design to compare the fibrinolytic agent instillation and the VATS as the first step treatment of childhood empyema are needed.

Original languageEnglish
JournalActa Paediatrica Taiwanica
Volume48
Issue number5
Publication statusPublished - Sep 2007

Fingerprint

Empyema
Streptokinase
Drainage
Video-Assisted Surgery
Thoracoscopes
Therapeutics
Chest Tubes
Pediatrics
Pleural Empyema
Bacterial Pneumonia
Pleurisy
Fibrinolytic Agents
Urokinase-Type Plasminogen Activator
Tissue Plasminogen Activator
Hospitalization
Research Design
Fever
Catheters
Morbidity

Keywords

  • Empyema
  • Intrapleural instillation
  • Pneumonia
  • Streptokinase

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Intrapleural streptokinase for the treatment of childhood empyema. / Ho, Man Yau; Chen, Hsiang Yin; Yen, Yu Hsuan; Yang, Yao Shun; Lien, Shao Hung.

In: Acta Paediatrica Taiwanica, Vol. 48, No. 5, 09.2007.

Research output: Contribution to journalArticle

Ho, Man Yau ; Chen, Hsiang Yin ; Yen, Yu Hsuan ; Yang, Yao Shun ; Lien, Shao Hung. / Intrapleural streptokinase for the treatment of childhood empyema. In: Acta Paediatrica Taiwanica. 2007 ; Vol. 48, No. 5.
@article{159539d55e2e4f2e9ae993ca117b9055,
title = "Intrapleural streptokinase for the treatment of childhood empyema",
abstract = "Background: Pleuritis with empyema is a serious complication of bacterial pneumonia, which often causes substantial morbidity and mortality among pediatric patients. Currently percutaneous catheter drainage is the mainstay therapy for loculated empyema. Intrapleural instillation of streptokinase, urokinase, and recombinant tissue plasminogen activator has been reported to facilitate the drainage of viscous fluid and fibrinous debris or multiple loculations from the pleural space of such patients. Methods: In this study, we compared with the treatments of pleural empyema by instillation of streptokinase through the chest tube and using the conventional chest tube drainage alone. Results: We collected 21 cases from 1999 through 2005. The results of the study showed that streptokinase (SK) group patients revealed a larger volume of drainage in the beginning days of the instillation and required fewer days of drainage than tube drainage (T) group patients [8 (4.5 - 10) days vs. 16 (5.8 - 20.3) days, p = 0.02]; that the SK group patients required average 2.6 instillations. The SK patients had a shorter febrile course than the T group [12.5 (9.5 - 15.5) days vs. 16 (9.5 - 22.5) days, p = 0.14]. None of the SK patients needed additional video-assisted thoracoscope surgery (VATS) whereas 5 patients in the T group did. The length of hospitalization in the SK group was 21.5 days and the T group patients was 24 days. Conclusions: Intrapleural instillation of streptokinase seldom caused clinical adverse effect and appears to be a safe adjunctive therapy to facilitate the drainage of empyema in pediatric patients. Further studies with better research design to compare the fibrinolytic agent instillation and the VATS as the first step treatment of childhood empyema are needed.",
keywords = "Empyema, Intrapleural instillation, Pneumonia, Streptokinase",
author = "Ho, {Man Yau} and Chen, {Hsiang Yin} and Yen, {Yu Hsuan} and Yang, {Yao Shun} and Lien, {Shao Hung}",
year = "2007",
month = "9",
language = "English",
volume = "48",
journal = "Pediatrics and Neonatology",
issn = "1875-9572",
publisher = "臺灣兒科醫學會",
number = "5",

}

TY - JOUR

T1 - Intrapleural streptokinase for the treatment of childhood empyema

AU - Ho, Man Yau

AU - Chen, Hsiang Yin

AU - Yen, Yu Hsuan

AU - Yang, Yao Shun

AU - Lien, Shao Hung

PY - 2007/9

Y1 - 2007/9

N2 - Background: Pleuritis with empyema is a serious complication of bacterial pneumonia, which often causes substantial morbidity and mortality among pediatric patients. Currently percutaneous catheter drainage is the mainstay therapy for loculated empyema. Intrapleural instillation of streptokinase, urokinase, and recombinant tissue plasminogen activator has been reported to facilitate the drainage of viscous fluid and fibrinous debris or multiple loculations from the pleural space of such patients. Methods: In this study, we compared with the treatments of pleural empyema by instillation of streptokinase through the chest tube and using the conventional chest tube drainage alone. Results: We collected 21 cases from 1999 through 2005. The results of the study showed that streptokinase (SK) group patients revealed a larger volume of drainage in the beginning days of the instillation and required fewer days of drainage than tube drainage (T) group patients [8 (4.5 - 10) days vs. 16 (5.8 - 20.3) days, p = 0.02]; that the SK group patients required average 2.6 instillations. The SK patients had a shorter febrile course than the T group [12.5 (9.5 - 15.5) days vs. 16 (9.5 - 22.5) days, p = 0.14]. None of the SK patients needed additional video-assisted thoracoscope surgery (VATS) whereas 5 patients in the T group did. The length of hospitalization in the SK group was 21.5 days and the T group patients was 24 days. Conclusions: Intrapleural instillation of streptokinase seldom caused clinical adverse effect and appears to be a safe adjunctive therapy to facilitate the drainage of empyema in pediatric patients. Further studies with better research design to compare the fibrinolytic agent instillation and the VATS as the first step treatment of childhood empyema are needed.

AB - Background: Pleuritis with empyema is a serious complication of bacterial pneumonia, which often causes substantial morbidity and mortality among pediatric patients. Currently percutaneous catheter drainage is the mainstay therapy for loculated empyema. Intrapleural instillation of streptokinase, urokinase, and recombinant tissue plasminogen activator has been reported to facilitate the drainage of viscous fluid and fibrinous debris or multiple loculations from the pleural space of such patients. Methods: In this study, we compared with the treatments of pleural empyema by instillation of streptokinase through the chest tube and using the conventional chest tube drainage alone. Results: We collected 21 cases from 1999 through 2005. The results of the study showed that streptokinase (SK) group patients revealed a larger volume of drainage in the beginning days of the instillation and required fewer days of drainage than tube drainage (T) group patients [8 (4.5 - 10) days vs. 16 (5.8 - 20.3) days, p = 0.02]; that the SK group patients required average 2.6 instillations. The SK patients had a shorter febrile course than the T group [12.5 (9.5 - 15.5) days vs. 16 (9.5 - 22.5) days, p = 0.14]. None of the SK patients needed additional video-assisted thoracoscope surgery (VATS) whereas 5 patients in the T group did. The length of hospitalization in the SK group was 21.5 days and the T group patients was 24 days. Conclusions: Intrapleural instillation of streptokinase seldom caused clinical adverse effect and appears to be a safe adjunctive therapy to facilitate the drainage of empyema in pediatric patients. Further studies with better research design to compare the fibrinolytic agent instillation and the VATS as the first step treatment of childhood empyema are needed.

KW - Empyema

KW - Intrapleural instillation

KW - Pneumonia

KW - Streptokinase

UR - http://www.scopus.com/inward/record.url?scp=38749147679&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=38749147679&partnerID=8YFLogxK

M3 - Article

C2 - 18254573

AN - SCOPUS:38749147679

VL - 48

JO - Pediatrics and Neonatology

JF - Pediatrics and Neonatology

SN - 1875-9572

IS - 5

ER -