We read with interest the letter by Playforet al 1 relating to childhood empyema in Nottingham. Many centres in the UK have noted an increase in this condition over the past three years and, indeed, it has been the subject of discussions at recent meetings of the British Paediatric Respiratory Society (BPRS). Urokinase has been used spasmodically in childhood empyema in the UK over the past three years and one of us (AHT) has used it successfully in 28 consecutive patients.

A decision was taken at the BPRS to instigate a national study to compare the effectiveness of intrapleural urokinase with normal saline. The study received MREC approval and has now been underway for approximately 12 months. Another 40 patients are needed for the trial to be completed. If any centres would like to take part would they please contact Anne Thomson, Department of Paediatrics, The John Radcliffe Hospital, Oxford.

We hope that this study will answer the questions raised by Playforet al and thank everyone who has so far participated in the study.