Chest
Clinical InvestigationsIntrapleural Streptokinase as Adjunctive Treatment for Persistent Empyema in Pediatric Patients
Section snippets
METHODS
Five consecutive cases of persistent empyema were retrospectively reviewed. All patients did not improve significantly with conventional therapy, including intravenous antibiotics and thoracostomy drainage and all were considered candidates for surgical decortication. Pleural fluid examination confirmed empyema in all patients.
Our protocol for the use of intrapleural streptokinase was as follows: pretreatment with analgesic and documentation of normal coagulation status. Instill 200,000 to
RESULTS
Table 1 summarizes clinical information on five pediatric empyema patients. Ages ranged from 18 months to 7 years. They experienced rapid improvement of their empyema following intrapleural streptokinase. Figure 1 depicts changes in chest tube drainage volume in relation to streptokinase infusion. Concurrently, all patients markedly improved clinically following streptokinase. Representative chest radiographs for case 5 are shown in Figure 2 (prestreptokinase), Figure 3 (after second
DISCUSSION
Streptokinase is a purified proteolytic enzyme produced from a bacterial protein of group C β-hemolytic streptococci. Streptokinase converts plasminogen to plasmin, an enzyme with proteolytic activity. Plasmin degrades fibrin clots as well as fibrinogen.6
The use of fibrinolytic enzymes to liquify fibrinous pleural exudates was first reported in 1949 by Tillett and Sherry.7 Sporadic case reports have followed the initial description, but these have rarely involved pediatric patients.8, 9, 10, 11
ACKNOWLEDGMENT:
The authors appreciate the editorial assistance of Natalie Purse.
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Manuscript received May 8, revision accepted August 5.