Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1994 Sep;49(9):852–855. doi: 10.1136/thx.49.9.852

Role of streptokinase in the treatment of acute loculated parapneumonic pleural effusions and empyema.

D Bouros 1, S Schiza 1, P Panagou 1, J Drositis 1, N Siafakas 1
PMCID: PMC475167  PMID: 7940420

Abstract

BACKGROUND--Intrapleural administration of streptokinase has been shown in a few small series to be effective treatment for complicated parapneumonic effusions and pleural empyemas, but techniques of instillation of streptokinase differ. The role of streptokinase in promoting drainage was investigated prospectively in a larger series of patients with complicated parapneumonic effusions and pleural empyemas. METHODS--Twenty consecutive patients with parapneumonic effusions, 15 with complicated parapneumonic effusions and five with pleural empyemas, drawn from 160 patients presenting with pleural effusions were studied. The age of the patients ranged from 15 to 92 years. Initial thoracocentesis showed mean (SD) values of pH 7.1 (0.15), glucose 45.9 (17.5) mg/dl, white blood cell count 12,000 (6627)/mm3. Streptokinase was administered intrapleurally in a single daily dose of 250,000 units in 100 ml normal saline via the chest tube once the drainage was < 100 ml/24 hours. Patients were treated for 3-10 (mean 6) days. RESULTS--Following administration of streptokinase a clinical and radiological improvement was noted in all but one patient who died on the fourth day of hospitalisation due to widespread adenocarcinoma. Another patient with clinical but minimal radiological improvement underwent thoracotomy, but a clear pleural space with only fibrotic changes was found. The mean (SD) volume of fluid drained 24 hours before streptokinase was 42.5 (39) ml, which increased in the first 24 hours after streptokinase to 334 (130) ml. Radiological evaluation showed an excellent improvement in 14 of the 20 patients, a moderate improvement in three, and minimal improvement in the remaining three patients. One patient developed a high fever as an adverse reaction to streptokinase. All 19 patients who completed the treatment were well at follow up 6-30 months (mean 15 months) later. CONCLUSIONS--Intrapleural instillation of streptokinase is an effective and safe mode of treatment for complicated parapneumonic effusions and pleural empyemas and alleviates the need for thoracotomy.

Full text

PDF
852

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alfageme I., Muñoz F., Peña N., Umbría S. Empyema of the thorax in adults. Etiology, microbiologic findings, and management. Chest. 1993 Mar;103(3):839–843. doi: 10.1378/chest.103.3.839. [DOI] [PubMed] [Google Scholar]
  2. Aye R. W., Froese D. P., Hill L. D. Use of purified streptokinase in empyema and hemothorax. Am J Surg. 1991 May;161(5):560–562. doi: 10.1016/0002-9610(91)90899-o. [DOI] [PubMed] [Google Scholar]
  3. Bartlett J. G., Finegold S. M. Anaerobic infections of the lung and pleural space. Am Rev Respir Dis. 1974 Jul;110(1):56–77. doi: 10.1164/arrd.1974.110.1.56. [DOI] [PubMed] [Google Scholar]
  4. Bergh N. P., Ekroth R., Larsson S., Nagy P. Intrapleural streptokinase in the treatment of haemothorax and empyema. Scand J Thorac Cardiovasc Surg. 1977;11(3):265–268. [PubMed] [Google Scholar]
  5. Fraedrich G., Hofmann D., Effenhauser P., Jander R. Instillation of fibrinolytic enzymes in the treatment of pleural empyema. Thorac Cardiovasc Surg. 1982 Feb;30(1):36–38. doi: 10.1055/s-2007-1022203. [DOI] [PubMed] [Google Scholar]
  6. Henke C. A., Leatherman J. W. Intrapleurally administered streptokinase in the treatment of acute loculated nonpurulent parapneumonic effusions. Am Rev Respir Dis. 1992 Mar;145(3):680–684. doi: 10.1164/ajrccm/145.3.680. [DOI] [PubMed] [Google Scholar]
  7. Light R. W., Girard W. M., Jenkinson S. G., George R. B. Parapneumonic effusions. Am J Med. 1980 Oct;69(4):507–512. doi: 10.1016/0002-9343(80)90460-x. [DOI] [PubMed] [Google Scholar]
  8. Light R. W. Parapneumonic effusions and empyema. Clin Chest Med. 1985 Mar;6(1):55–62. [PubMed] [Google Scholar]
  9. Mitchell M. E., Alberts W. M., Chandler K. W., Goldman A. L. Intrapleural streptokinase in management of parapneumonic effusions. Report of series and review of literature. J Fla Med Assoc. 1989 Dec;76(12):1019–1022. [PubMed] [Google Scholar]
  10. Moulton J. S., Moore P. T., Mencini R. A. Treatment of loculated pleural effusions with transcatheter intracavitary urokinase. AJR Am J Roentgenol. 1989 Nov;153(5):941–945. doi: 10.2214/ajr.153.5.941. [DOI] [PubMed] [Google Scholar]
  11. Ogirala R. G., Williams M. H., Jr Streptokinase in a loculated pleural effusion. Effectiveness determined by site of instillation. Chest. 1988 Oct;94(4):884–886. doi: 10.1378/chest.94.4.884. [DOI] [PubMed] [Google Scholar]
  12. Sahn S. A. State of the art. The pleura. Am Rev Respir Dis. 1988 Jul;138(1):184–234. doi: 10.1164/ajrccm/138.1.184. [DOI] [PubMed] [Google Scholar]
  13. Strange C., Sahn S. A. The clinician's perspective on parapneumonic effusions and empyema. Chest. 1993 Jan;103(1):259–261. doi: 10.1378/chest.103.1.259. [DOI] [PubMed] [Google Scholar]
  14. TILLETT W. S., SHERRY S., READ C. T. The use of streptokinase-streptodornase in the treatment of postneumonic empyema. J Thorac Surg. 1951 Mar;21(3):275–297. [PubMed] [Google Scholar]
  15. Tillett W. S., Sherry S. THE EFFECT IN PATIENTS OF STREPTOCOCCAL FIBRINOLYSIN (STREPTOKINASE) AND STREPTOCOCCAL DESOXYRIBONUCLEASE ON FIBRINOUS, PURULENT, AND SANGUINOUS PLEURAL EXUDATIONS. J Clin Invest. 1949 Jan;28(1):173–190. doi: 10.1172/JCI102046. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Willsie-Ediger S. K., Salzman G., Reisz G., Foreman M. G. Use of intrapleural streptokinase in the treatment of thoracic empyema. Am J Med Sci. 1990 Nov;300(5):296–300. doi: 10.1097/00000441-199011000-00005. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES