Use of fibrinolytic agents in the management of complicated XXXX and empyemas.

@entity1 @entity2261 @entity1143 @entity32 @entity868 @entity548 @entity281 @entity456
BACKGROUND: Standard treatment for @entity281 includes catheter drainage and antibiotics. Tube drainage often fails if the fluid is loculated by fibrinous adhesions when surgical drainage is needed. Streptokinase may aid the process of @entity456 , but there have been no controlled trials to assess its efficacy. METHODS: Twenty four @entity1 with infected community acquired @entity1143 were studied. All had either frankly purulent/culture or Gram stain positive pleural fluid (13 cases; 54%) or fluid which fulfilled the biochemical criteria for @entity281 . Fluid was drained with a 14F catheter. The antibiotics used were @entity2261 and @entity868 or were guided by culture. Subjects were randomly assigned to receive intrapleural streptokinase, 250,000 IU daily, or control saline flushes for three days. The primary end points related to the efficacy of @entity456 --namely, the volume of pleural fluid drained and the chest radiographic response to treatment. Other end points were the number of pleural procedures needed and blood indices of @entity32 . RESULTS: The streptokinase group drained more pleural fluid both during the days of streptokinase/control treatment (mean (SD) 391 (200) ml versus 124 (44) ml; difference 267 ml, 95% confidence interval (CI) 144 to 390; p < 0.001) and overall (2564 (1663) ml versus 1059 (502) ml; difference 1505 ml, 95% CI 465 to 2545; p < 0.01). They showed greater improvement on the chest radiograph at discharge, measured as the fall in the maximum dimension of the pleural collection (6.0 (2.7) cm versus 3.4 (2.7) cm; difference 2.9 cm, 95% CI 0.3 to 4.4; p < 0.05) and the overall reduction in pleural fluid collection size (p < 0.05, two tailed Fisher's exact test). Systemic fibrinolysis and @entity548 complications did not occur. Surgery was required by three control @entity1 but none in the streptokinase group. CONCLUSIONS: Intrapleural streptokinase probably aids the treatment of @entity281 by improving @entity456 without causing systemic fibrinolysis or local @entity548 .
