[Using of fibrinolytics in the treatment of complicated parapneumonic effusion and empyema in children]

Abstract

Bacterial pneumonia is associated with a high incidence of pleural effusions in children. These parapneumonic effusions usually resolve spontaneously if patients are treated with appropriate antibiotics. However, a small percentage of parapneumonic effusions will become complicated, either loculated non-purulent fluid or an empyema. The traditional therapeutic approaches for complicated parapneumonic effusions includes catheter drainage and systemic antibiotics. Tube drainage often fails if the fluid is loculated by fibrinous adhesions and surgical operation require. Intrapleural administration of fibrinolytics is an effective treatment for complicated parapneumonic effusions and pleural empyemas, improving the drainage without causing systemic fibrinolysis or local hemorrhage. The global success rate were between 44% and 100%, in most cases more than 80%. Both streptokinase and urokinase have been used for this purpose but there are few reports of their use in the children. Intrapleural streptokinase and urokinase are equally efficacious in treating complicated parapneumonic effusions and empyemas. Intrapleural instillation of fibrinolytics is an effective and safe mode of treatment for complicated parapneumonic effusions and pleural empyemas, and may reduce the need for more invasive surgical procedures.