Skip to main content

Advertisement

SpringerLink
Log in

Intrapleural streptokinase treatment in children with empyema

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Our aim was to compare intrapleural streptokinase (SK) treatment and simple tube drainage in the treatment of children with complicated parapneumonic pleural effusion. A retrospective review of medical records included patient demographics, clinical presentation, biochemical and microbial studies of pleural effusion, radiographic evaluation of chest tube drainage, use of fibrinolytic agents and type of surgical intervention. During the 2.5-year period (1999–2002), 53 children (29 M, 24 F) with complicated parapneumonic effusions or empyema were identified. Closed tube drainage and antibiotic treatment were administered to patients with a diagnosis of complicated parapneumonic effusion (n = 24) until October 2000; after that time point, intrapleural streptokinase was added to this regimen (n = 29). The median age at the time of presentation was 2.5 years (range: 5 months-14.6 years). There were no significant differences in terms of clinical outcomes between the two groups. The average length of hospital stay was 19.1 ± 5.5 and 21.9 ± 11.2 days for the drainage and streptokinase groups, respectively; the time to afebrile state after admission was 5.8 ± 4.1 and 7.6 ± 7.5 days. The percentage of patients who eventually required surgical intervention was 8.3% for the drainage group and 20.6% for the streptokinase group. In conclusion, in the treatment of complicated parapneumonic effusions or empyema, the adjunctive treatment with intrapleural SK does not significantly reduce durations of fever, chest tube drainage and hospital stay, and the need for surgery, regardless of the stage of the disease, compared to simple closed tube drainage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Avansino JR, Goldman B, Sawin RS, Flum D (2005) Primary operative versus nonoperative therapy for pediatric empyema: a meta-analysis. Pediatrics 115:1652–1658

    Article  PubMed  Google Scholar 

  2. Barbato A, Panizzolo C, Monciotti C, Marcucci F, Stefanutti G, Gamba PG (2003) Use of urokinase in childhood pleural empyema. Pediatr Pulmonol 35:50–55

    Article  PubMed  CAS  Google Scholar 

  3. Barnes NP, Hull J, Thomson AH (2005) Medical management of parapneumonic pleural disease. Pediatr Pulmonol 39:127–134

    Article  PubMed  CAS  Google Scholar 

  4. Bouros D, Schiza S, Patsourakis G, Chalkiadakis G, Panagou P, Siafakas NM (1997) Intrapleural streptokinase versus urokinase in the treatment of complicated parapneumonic effusions: a prospective, double-blind study. Am J Respir Crit Care Med 155:291–295

    PubMed  CAS  Google Scholar 

  5. Bouros D, Schiza S, Tzanakis N, Chalkiadakis G, Drositis J, Siafakas N (1999) Intrapleural urokinase versus normal saline in the treatment of complicated parapneumonic effusions and empyema. Am J Respir Crit Care Med 159:37–42

    PubMed  CAS  Google Scholar 

  6. Cameron R, Davies HR (2004) Intra-pleural fibrinolytic therapy versus conservative management in the treatment of parapneumonic effusions and empyema. Cochrane Database Syst Rev (2):CD002312

  7. Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B, Sahn S, Weinstein RA, Yusen RD (2000) Medical and surgical treatment of parapneumonic effusions: an evidence-based guideline. Chest 118:1158–1171

    Article  PubMed  CAS  Google Scholar 

  8. Davies CW, Gleeson FV, Davies RJ (2003) BTS guidelines for the management of pleural infection. Thorax 58(Suppl 2):ii18–ii28

    PubMed  Google Scholar 

  9. Davies RJ, Traill ZC, Gleeson FV (1997) Randomized controlled trial of intrapleural streptokinase in community acquired pleural infection. Thorax 52:416–421

    Article  PubMed  CAS  Google Scholar 

  10. Diacon AH, Theron J, Schuurmans MM, Van De Wal BW, Bolliger CT (2004) Intrapleural streptokinase for empyema and complicated parapneumonic effusions. Am J Respir Crit Care Med 170:49–53

    Article  PubMed  Google Scholar 

  11. Hilliard TN, Henderson AJ, Langton Hewer SC (2003) Management of parapneumonic effusion and empyema. Arch Dis Child 88:915–917

    Article  PubMed  CAS  Google Scholar 

  12. Kilic N, Celebi S, Gurpinar A, Hacimustafaoglu M, Konca Y, Ildirim I, Dogruyol H (2002) Management of thoracic empyema in children. Pediatr Surg Int 18:21–23

    Article  PubMed  Google Scholar 

  13. Kornecki A, Sivan Y (1997) Treatment of loculated pleural effusion with intrapleural urokinase in children. J Pediatr Surg 32:1473–1475

    Article  PubMed  CAS  Google Scholar 

  14. Krishnan S, Amin N, Dozor AJ, Stringel G (1997) Urokinase in the management of complicated parapneumonic effusions in children. Chest 112:1579–1583

    Article  PubMed  CAS  Google Scholar 

  15. LeMense GP, Strange C, Sahn SA (1995) Empyema thoracis. Therapeutic management and outcome. Chest 107:1532–1537

    Article  PubMed  CAS  Google Scholar 

  16. Light RW, Girard WM, Jenkinson SG, George RB (1980) Parapneumonic effusions. Am J Med 69:507–512

    Article  PubMed  CAS  Google Scholar 

  17. Maskell NA, Davies CW, Nunn AJ, Hedley EL, Gleeson FV, Miller R, Gabe R, Rees GL, Peto TE, Woodhead MA, Lane DJ, Darbyshire JH, Davies RJ (2005) First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 352:865–874

    Article  PubMed  CAS  Google Scholar 

  18. Miller MA, Ben-Ami T, Daum RS (1999) Bacterial pneumonia in neonates and older children. In: Taussig LM, Landau LI, Le Souef PN, Morgan WJ, Martinez FD, Sly PD (eds) Pediatric respiratory medicine. Mosby, St. Louis, MO, pp 595–664

    Google Scholar 

  19. Ozcelik C, Inci I, Nizam O, Onat S (2003) Intrapleural fibrinolytic treatment of multiloculated postpneumonic pediatric empyemas. Ann Thorac Surg 76:1849–1853

    Article  PubMed  Google Scholar 

  20. Rosen H, Nadkarni V, Theroux M, Padman R, Klein J (1993) Intrapleural streptokinase as adjunctive treatment for persistent empyema in pediatric patients. Chest 103:1190–1193

    Article  PubMed  CAS  Google Scholar 

  21. Shankar KR, Kenny SE, Okoye BO, Carty HM, Lloyd DA, Losty PD (2000) Evolving experience in the management of empyema thoracis. Acta Paediatr 89:417–420

    Article  PubMed  CAS  Google Scholar 

  22. Thomson AH, Hull J, Kumar MR, Wallis C, Balfour Lynn IM (2002) Randomised trial of intrapleural urokinase in the treatment of childhood empyema. Thorax 57:343–347

    Article  PubMed  CAS  Google Scholar 

  23. Tillet WS, Sherry S (1949) The effect in patients of streptococcal fibrinolysin (streptokinase) and streptococcal deoxyribonuclease on fibrinous, purulent, and sanguinous pleural exudations. J Clin Invest 28:173–190

    Article  Google Scholar 

  24. Tuncozgur B, Ustunsoy H, Sivrikoz MC, Dikensoy O, Topal M, Sanli M, Elbeyli L (2001) Intrapleural urokinase in the management of parapneumonic empyema: a randomised controlled trial. Int J Clin Pract 55:658–660

    PubMed  CAS  Google Scholar 

  25. Ulku R, Onen A, Onat S, Kilinc N, Ozcelik C (2004) Intrapleural fibrinolytic treatment of multiloculated pediatric empyemas. Pediatr Surg Int 20:520–524

    Article  PubMed  Google Scholar 

  26. Yao CT, Wu JM, Liu CC, Wu MH, Chuang HY, Wang JN (2004) Treatment of complicated parapneumonic pleural effusion with intrapleural streptokinase in children. Chest 125:566–571

    Article  PubMed  CAS  Google Scholar 

  27. Wheeler JG, Jacops RF (2004) Pleural effusions and empyema. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL (eds) Textbook of pediatric infectious diseases, 5th edn. Saunders, Philadelphia, pp 320–330

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Allergy, School of Medicine, Kocaeli University, Kocaeli, Turkey

    Metin Aydoğan & Ayşen Aydoğan

  2. Department of Pediatrics, School of Medicine, Kocaeli University, Kocaeli, Turkey

    Ayla Özcan, Ayse Sevim Gokalp & Emin Sami Arısoy

  3. Department of Pediatric Surgery, School of Medicine, Kocaeli, Turkey

    Melih Tugay

  4. Hatboyu Ege Sokak, Sermet Apt. No:1, D:9, Göztepe/Kadıköy/İstanbul, 81060, Turkey

    Metin Aydoğan

Authors
  1. Metin Aydoğan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayşen Aydoğan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ayla Özcan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Melih Tugay
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ayse Sevim Gokalp
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emin Sami Arısoy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Metin Aydoğan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aydoğan, M., Aydoğan, A., Özcan, A. et al. Intrapleural streptokinase treatment in children with empyema. Eur J Pediatr 167, 739–744 (2008). https://doi.org/10.1007/s00431-007-0580-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-007-0580-2

Keywords

Search

Navigation