Treatment of complicated parapneumonic pleural effusion with intrapleural streptokinase in children.
OBJECTIVE
To evaluate the role of intrapleural streptokinase in the management of complicated parapneumonic effusions in children.


METHODS
Prospective comparative study.


METHODS
Cheng Kung University Hospital, a tertiary medical center in Tainan, Taiwan.


METHODS
We enrolled as our prospective study group 20 consecutive children with complicated parapneumonic effusions who received intrapleural streptokinase treatment between August 2000 and July 2002. We also retrospectively analyzed a comparison group of 22 consecutive children with complicated parapneumonic effusions who received chest tube drainage without streptokinase treatment from January 1992 to July 2000. We then compared the clinical manifestations and outcome of these two patient groups. The patient population (21 boys and 21 girls) ranged in age from 9 to 130 months (mean age, 41.5 +/- 26.3 months [mean +/- SD]). The characters of pleural effusion showed no difference between the two groups. Nineteen patients had positive findings for Streptococcus pneumoniae, 2 patients had positive findings for Staphylococcus aureus, 2 patients had positive findings for Pseudomonas aeruginosa, and 19 patients had undetermined pathogens. All patients were treated with appropriate antibiotics.


RESULTS
More pleural fluid was drained from the streptokinase group than from the comparison group during streptokinase treatment (816 +/- 481 mL vs 279 +/- 238 mL, p < 0.01). The duration of fever after chest tube insertion was also significantly lower in the study group (5.3 +/- 3.1 days vs 7.9 +/- 4.6 days, p < 0.05). Only two patients in the streptokinase group required surgical intervention compared with nine patients in the comparison group (p < 0.05). No major side effects were noticed after streptokinase instillation.


CONCLUSIONS
Intrapleural fibrinolytic treatment with streptokinase is safe and effective, and it can obviate the need for surgery in most cases. The combination treatment should be attempted early on, when complicated parapneumonic effusion is first diagnosed.
Yao
Chih-Ta
CT
Department of Pediatrics, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan 704, Taiwan, ROC.
Wu
Jing-Ming
JM
Liu
Ching-Chuan
CC
Wu
Ming-Ho
MH
Chuang
Hung-Yi
HY
Wang
Jieh-Neng
JN
D015505:Chest Tubes; D002675:Child, Preschool; D004322:Drainage / Q000379:methods; D016724:Empyema, Pleural / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional; D008297:Male; D010994:Pleura / Q000187:drug effects; D010996:Pleural Effusion / Q000188:drug therapy* / Q000382:microbiology; D011336:Probability; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy*; D013300:Streptokinase / Q000008:administration & dosage*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D013300:Streptokinase