title: Two sequential tPA/DNase courses for noncommunicating loculated collections in pleural infection.
abstract: Intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) therapy is being increasingly employed as an alternative to surgical intervention for the treatment of complicated parapneumonic effusions and empyema. Published cases are limited to one randomized control trial and few case reports. No data exist on employing sequential or repeated courses of intrapleural tPA/DNase to aid evacuation of separate collections in patients' with a multiloculated pleural infection. This is the first report of successful use of sequential delivery of separate courses of intrapleural tPA/DNase to two noncommunicating infected pleural fluid collections within the same hemithorax of a patient. Our case confirms that prior treatment with tPA/DNase therapy does not preclude subsequent effective and safe use of this intrapleural treatment.
authors.affiliation: Pharmacy Department, Sir Charles Gairdner Hospital Perth, Western Australia, Australia ; Centre for Asthma, Allergy & Respiratory Research, School of Medicine & Pharmacology, University of Western Australia Perth, Western Australia, Australia.
authors.forename: Natalia
authors.initials: N
authors.lastname: Popowicz
authors.affiliation: Department of Medicine, Swan District Hospital Perth, Western Australia, Australia.
authors.forename: Francesco
authors.initials: F
authors.lastname: Piccolo
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital Perth, Western Australia, Australia.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Shrestha
authors.affiliation: Centre for Asthma, Allergy & Respiratory Research, School of Medicine & Pharmacology, University of Western Australia Perth, Western Australia, Australia ; Department of Respiratory Medicine, Sir Charles Gairdner Hospital Perth, Western Australia, Australia.
authors.forename: Y C Gary
authors.initials: YC
authors.lastname: Lee
keywords: Deoxyribonuclease; empyema; fibrinolytics; pleural infection; tissue plasminogen activator