Intrapleural streptokinase in management of complicated parapneumonic effusion and empyema

We report our study of the use of intrapleural streptokinase [IPSK] in ten patients with multiloculated complicated parapneumonic effusion and empyema who had failure of conservative first line of treatment with antibiotics and intercostal tube drainage. In order to break the multiple loculi and facilitate tube drainage, we instilled intrapleurally streptokinase 250,000 units diluted in 100 ml of 0.9% saline. All our patients showed improved fluid drainage after IPSK. Five patients experienced clinical and radiological resolution. IPSK therapy was unsuccessful in the remaining five, who then underwent successful surgical intervention