New therapy of pleural empyema by deoxyribonuclease

Abstract

Empyema is a severe complication of different diseases and traumas. Management of this complication is difficult and should comprise general and local procedures. The general procedure is mainly based on administering wide-spectrum antibiotics. Local management depends on patient general condition, but in all cases the essential procedure is to insert a drain into the pleural cavity and to evacuate the pus. Sometimes pus is very thick and its evacuation and following re-expansion of the lung is rather impossible. In these patients surgical intervention is needed. The use of intrapleural enzymes to support the drainage was first described in 1949 by Tillett and Sherry using a mixture of streptokinase and streptococcal deoxyribonuclease. Nowadays, purified streptokinase has come into widespread use, but recent studies reported no streptokinase effect on pus viscosity. On the other side, deoxyribonuclease reduces pus viscosity and may be more useful in treatment. We report two cases of intrapleural administration of Pulmozyme (alfa dornase - deoxyribonuclease (HOFFMANN-LA ROCHE AG) in dosage 2×2.5mg with a significant improvement caused by changes in pus viscosity.

Fig. 1

Patient no. 1. (A) Chest X-ray performed before treatment. (B) Chest X-ray performed after inserting drain. (C) Chest X-ray performed after introducing two doses of Pulmozyme. (D) Chest X-ray performed after removing drain.

Fig. 2

Patient no. 2. (A) Chest X-ray performed before treatment. (B) Chest X-ray performed after inserting drain. (C) Chest X-ray performed after introducing two doses of Pulmozyme. (D) Chest X-ray performed after removing drain.