ABSTRACT
Background: Standard treatment for pleural infection includes of drainage and antibiotics. Chest tube drainage often fails if the fluid is loculated by fibrinous adhesions. Intrapleural fibrinolysis may facilitate pleural drainage. Objective: To evaluate the role of Streptokinase (STK) in the treatment of empyema and exudative pleural effusions. Subjects and method: A study included 34 patients (21 patients with exudative pleural effusions, 13 patients with empyema), aged 15-77 years. All patients received intrapleural STK daily with dose of 300.0000-500.000 UI for empyema and 300.000 UI for exudative pleural effusions. Response was assessed by clinical outcome, pleural fluid drainage, chest radiography, pleural ultrasound. Results: Mean pleural fluid drainage after STK instillation was higher in all patients. Pleural fluid drainage was 640 \xb1 494 ml before STK instillation and 823 \xb1 755 ml after STK instillation for empyema; 765 \xb1 691 ml before STK instillation and 1,033 \xb1 757 ml after STK instillation for exudative pleural effusions. The success rate of clinical outcome was 100%. Only 2 patients required decortications. Fever occurred in 3 patients (8.8%) and allergy in 1 patient (3%). Conclusions: Intrapleural STK was safe and effective in the treatment of empyema and exudative pleural effusions. STK prevents pleural adhesions and reduces the risks for surgery.