Intrapleurally administered streptokinase in management of loculated empyema

Intrapleural streptokinase was used in 22 patients with loculated empyema in whom intercostal tube thoracostomy was ineffective for drainage of the pleural space and they were potential c and idates for rib resection tube drainage to cut the septa. Effectiveness of intrapleural streptokinase was assessed radiographically and by monitoring the volume of fluid drained through chest tube in the first 48 hours. 14 patients [63.64%] showed radiological and clinical improvement. The time elapse between intercostal tube thoracostomy and instillation of streptokinase was important prognostic factor that determined the outcome of this procedure. In conclusion, intrapleural instillation of streptokinase is safe and effective in promoting drainage of loculated purulent effusion. Early administration may lead to fewer intrapleural installations and better response. Intrapleural administered streptokinase may decrease the number of patients for whom inadequate drainage might lead to rib resection tube drainage or decortication later