Role of intrapleural streptokinase in management of multiloculated thoracic empyemas

Multiloculated thoracic empyemas which are incompletely drained by tube thoracostomy alone usually require surgical intervention. Non surgical approach with the use of a fibrinolytic agent like streptokinase is an effective alternative modality which can avoid a thoracotomy. To evaluate the utility of streptokinase in the management of multiloculated empyemas, a single blind randomized case control study was conducted.36 cases of multiloculated thoracic empyemas were included with failure to drain less than 100 ml/24 hrs through tube thoracostomy. Cases were randomized into two groups as 18 cases of streptokinase group and 18 cases of control group. Streptokinase, 2.5 MU in 100 ml 0.9% saline solution was instilled daily into the chest tube for 6 consecutive days. In control group, 100 ml of normal saline was instilled intrapleurally through intercostal drain. Assessment was done on the basis of clinical improvement, amount of drainage, duration of chest tube in situ and radiological improvement by chest x-ray. The study revealed clinical improvement, increased drainage through chest tube, shorter duration of intercostal drainage in situ and radiological improvement in the streptokinase group compared to control group. The observation difference is found to be highly significant statistically. No major adverse effects were noted in streptokinase group.The study concludes the safety, efficacy, reduced hospital stay and decreased morbidity in patients of loculated empyemas in whom streptokinase was instilled intrapleurally as compared to control group.