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In October 1997 we reported an increase in the incidence of childhood empyema in Nottingham.1 There had been no cases of childhood empyema in the city between April 1994 and April 1996, yet there had been 11 cases between April 1996 and April 1997. We have now reviewed the data for the following 12 months, from April 1997 to April 1998. During this period we have seen only three children with a diagnosis of empyema at the two paediatric departments in the city—Queen’s Medical Centre and Nottingham City Hospital. During this period there have been no further reports of increased incidence of childhood empyema since the original report by Reeset al.2 One of the children admitted to Nottingham City Hospital in January 1998 was treated with intrapleural fibrinolysis. She received eight doses of urokinase administered into the pleural space via a pigtail catheter at 12 hourly intervals. A dose of 40 000 U urokinase was diluted in 40 ml on normal saline and instilled via the catheter, which was clamped for four hours and then placed on low grade suction for a further eight hours. This patient received 13 days of intravenous antibiotics and remained in hospital for 14 days; both of these values are less than the median values for duration of intravenous antibiotics and length of hospital admission found previously (15.5 days and 17 days, respectively).
It is interesting to read of the increasing use of intrapleural fibrinolysis in children in the form of case reports and small series3 4 where the treatment appears to be safe and effective. It is important, however, to emphasise the need for a randomised controlled trial of intrapleural fibrinolysis in children in order to demonstrate any benefit in terms of reducing hospital stay and preventing more invasive procedures.
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