Clinical presentation and management of empyema, lung abscess and pleural effusion.
OBJECTIVE
Pleural effusions, lung abscess and empyema remain a commonly encountered clinical problem and a significant source of morbidity. The aim of this review is to summarize recent developments with emphasis on controlled trials.


RESULTS
There is wide variation in the management of infectious pleural effusions, partly because of the relative lack of randomized controlled trials. The recent MRC/BTS UK controlled trial of interapleural streptokinase for pleural infection assessed the efficacy of intrapleural streptokinase compared with placebo in complicated parapneumonic effusions. The study showed no difference in the primary end point, mortality, or in the need for surgery or length of the hospital stay among patients with pleural infection. The first large report published for over a decade has suggested that the bacteriological characteristics of lung abscess have changed.


CONCLUSIONS
The major recent development in the management of pleural infections is the finding that we should dampen the ardor for the routine use of fibrinolytic agents in all patients with pleural infections. We strongly recommend the necessity for additional, well-designed trials to help determine optimal care for these seriously ill patients.
Schiza
Sophia
S
Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece.
Siafakas
Nikolaos M
NM
D000890:Anti-Infective Agents / Q000627:therapeutic use; D016724:Empyema, Pleural / Q000175:diagnosis / Q000628:therapy; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008169:Lung Abscess / Q000175:diagnosis / Q000628:therapy; D010996:Pleural Effusion / Q000175:diagnosis / Q000628:therapy; D013906:Thoracoscopy
D000890:Anti-Infective Agents; D005343:Fibrinolytic Agents