Pleural effusions and empyemas may complicate 20–57% of bacterial pneumonias. Clinical experience supports the use of fibrinolytic agents as a means of dissolving fibrin, releasing loculations and adhesions, thereby allowing for free drainage via thoracostomy tubes. Currently available thrombolytic agents include urokinase, tissue plasminogen activator (TPA), and streptokinase. Due to manufacturer-related issues, the supply of urokinase has become somewhat limited while streptokinase has the potential for allergic reactions in pediatric patients. The authors report the use of TPA as an adjunct to other therapies for treatment of empyema in a 6-year-old boy with pneumococcal pneumonia.
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References
1.
Taryl D,Potts D,Sahn S..The incidence and clinical correlates of parapneumonic effusions in pneumococcal pneumonia.Chest. 1978;74:170-173
Moulton J..Image-guided management of complicated pleural fluid collections.Radiol Clin N Am. 2000;38):345-374
4.
Doski J,Lou D,Hicks B.Management of parapneumonic collections in infants and children.J Pediatr Surg. 2000;35:265-270
5.
Muers M..Streptokinase for empyema.Lancet. 1997;349:1491-1492
6.
Bouros D,Schiza S,Tzanakis N.Intrapleural urokinase versus normal saline in the treatment of complicated parapneumonic effusions and empyema. A randomized double blind study.Am J Respir Care Crit Care Med. 1999;159:37-42
7.
Bouros D,Schiza S,Siafakas N..Utility of fibrinolytic agents for draining intrapleural infections.Semin Respir Infect. 1999;14:39-47
8.
Barletta J..Streptokinase and urokinase for the treatment of pleural effusions and empyemas.Ann Pharmacother. 1999;33:495-498
9.
Kornecki A,Sivan Y..Treatment of loculated pleural effusion with intrapleural urokinase in children.J Pediatr Surg. 1997;32:1473-1475
10.
Krishnan S,Amin N,Dozor Aj.Urokinase in the management of complicated parapneumonic effusions in children.Chest. 1997;112:1579-1583
11.
11.CastanedaF.Percutaneous drainage and fibrinolytic therapy for the treatment of loculated or complex pleural effusions [abstract]. Paper presented at the 8th Interventional Radiology and Endovascular Therapy Seminar. http://www.miit.com/percutaneous_drainage.htm.
12.
Nightingale Sl..From the Food and Drug Administration.JAMA. 1999;281:786
13.
Johnson Tr,Tobias Jd..Initial experience with tissue plasminogen activator in two pediatric oncology patients.J Intensive Care Med. 2000;15:53-58
