Treatment of Complicated Parapneumonic Pleural Effusion with Intrapleural Streptokinase in Children

Objective: To evaluate the role of intrapleural streptokinase in the management of complicated parapneumonic effusions in children. Design: Prospective comparative study. Setting: Cheng Kung University Hospital, a tertiary medical center in Tainan, Taiwan. Patients and methods: We enrolled as our prospective study group 20 consecutive children with complicated parapneumonic effusions who received intrapleural streptokinase treatment between August 2000 and July 2002. We also retrospectively analyzed a comparison group of 22 consecutive children with complicated parapneumonic effusions who received chest tube drainage without streptokinase treatment from January 1992 to July 2000. We then compared the clinical manifestations and outcome of these two patient groups. The patient population (21 boys and 21 girls) ranged in age from 9 to 130 months (mean age, 41.5 ± 26.3 months [mean ± SD]). The characters of pleural effusion showed no difference between the two groups. Nineteen patients had positive findings for Streptococcus pneumoniae, 2 patients had positive findings for Staphylococcus aureus, 2 patients had positive findings for Pseudomonas aeruginosa, and 19 patients had undetermined pathogens. All patients were treated with appropriate antibiotics. Results: More pleural fluid was drained from the streptokinase group than from the comparison group during streptokinase treatment (816 ± 481 mL vs 279 ± 238 mL, p < 0.01). The duration of fever after chest tube insertion was also significantly lower in the study group (5.3 ± 3.1 days vs 7.9 ± 4.6 days, p < 0.05). Only two patients in the streptokinase group required surgical intervention compared with nine patients in the comparison group (p < 0.05). No major side effects were noticed after streptokinase instillation. Conclusion: Intrapleural fibrinolytic treatment with streptokinase is safe and effective, and it can obviate the need for surgery in most cases. The combination treatment should be attempted early on, when complicated parapneumonic effusion is first diagnosed.