Abstract

Objective: Parapneumonic pleural effusions show a wide range, from minimal-uncomplicated pleural effusions to complicated effusions and empyema. At the present time, the use and benefit of intrapleural streptokinase in complicated cases, in addition to closed chest tube drainage and thoracoscopic methods, is still contraversial. The aim of this study was to evaluate the efficacy of intrapleural streptokinase in parapneumonic pleural effusions.

Material and Method: A total of 42 patients treated for complicated parapneumonic effusion and empyema, and having tube thoracostomy in the period of January 2000-December 2007, were included in the study. Properties of the cases were evaluated retrospectively. Mann-Withney U, Student-t and Fischer's Exact tests were used for statistical analysis.

Results: Twenty-two cases who had multiloculation detected by ultrasonography and/or culture positive pleural effusion, received intrapleural streptokinase, and 20 cases without septation or culture positivity had tube thoracostomy only. Statistically,there was no difference between the two groups for sex, age and comorbid disease. Success rate (complete lung expansion and chest tube removal) in the intrapleural streptokinase group was 86.4%, and 80%in the group with chest tube drainage only. There were no statistically significant differences between the two groups for hospital stay, tube thoracostomy duration, complication incidence and decortication need (p>0,05).

Conclusion: Our study showed that use of intrapleural streptokinase in complicated (culture positive and/or loculated) parapneumonic effusion and empyema were an effective treatment when cases were selected precisely, and it did not increase hospital stay and period of drainage compared to the second group.