Intra-pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema

Author(s) Altmann E.S.; Crossingham I.; Wilson S.; Davies H.R.
Source Cochrane Database of Systematic Reviews; Oct 2019; vol. 2019 (no. 10)
Background Pleural infection, including parapneumonic effusions and thoracic empyema, may complicate lower respiratory tract infections. Standard treatment of these collections in adults involves antibiotic therapy, effective drainage of infected fluid and surgical intervention if conservative management fails. Intrapleural fibrinolytic agents such as streptokinase and alteplase have been hypothesised to improve fluid drainage in complicated parapneumonic effusions and empyema and therefore improve treatment outcomes and prevent the need for thoracic surgical intervention. Intrapleural fibrinolytic agents have been used in combination with DNase, but this is beyond the scope of this review. 

• Available in full text at The Cochrane database of systematic reviews from Cochrane Collaboration (Wiley)