Comparison of Six versus Three Doses of Intrapleural Fibrinolytic Therapy in Children with Empyema: A Randomized Controlled Trial.

OBJECTIVES

To compare six doses of intrapleural streptokinase (SK) vs. the conventional three doses in children with empyema.

METHODS

In this randomized controlled trial, children with empyema received intrapleural streptokinase, either twice daily for 3 d (total 6 doses); or once daily for 3 d (total 3 doses). The outcomes assessed were treatment failure, volume of fluid drained, duration of fever, duration of respiratory distress, length of hospitalization, need for surgical decortication, adverse events and cost.

RESULTS

Thirty-six children were enrolled. Cumulative pleural pus drainage was significantly higher with six doses [median (IQR) 367 (266, 850) vs. 195 (142, 422) ml, p 0.02]. The mean (SD) durations of fever and respiratory distress, after completing intrapleural therapy were also shorter; 2.3 (0.8) vs. 5.7 (1.6) d, p 0.04; and 2.2 (0.9) vs. 6.3 (1.9) d, p 0.03 respectively. However, there were no statistically significant differences in the length of hospitalization after completing therapy [median (IQR) 9 (6, 17) vs. 12 (4, 16) d], total duration of intercostal drainage [median (IQR) 13 (11, 21) vs. 12 (7, 19) d], treatment failure rate [4/16 (25%) vs. 7/16 (43.7%)], or need for surgical decortication [2/16 (16.2%) vs. 1/16 (6.2%)]. There were no significant adverse effects necessitating cessation or modification of therapy in either group. The cost of therapy was identical in both groups.

CONCLUSIONS

Six doses of intrapleural streptokinase appear superior to the conventional three doses in children with empyema, with comparable safety and cost.