• Nisar Khan
  • Ihsanullah Mian
  • Arshad Javed
  • Samad Wazir
  • Mohammad Yousaf


Background: Empyema thoracis is a common illness with significant morbidity and mortality. Standard treatment of Empyema includes tube drainage and antibiotics. But the tube drainage often fails if the fluid is loculated. Intrapleural Streptokinase has been used in multiloculated empyemas with good success rate. We evaluated the efficacy and safety of intra-pleural Streptokinase in loculated empyemas. Methods: A total of 15 patients admitted in Pulmonology unit with multiloculated empyemas whose drainage via drainage tube was less than 100 ml during the last 24 hours were included in the study. Aliquots of 250,000 units of Streptokinase in 100 ml of normal saline were instilled into the pleural cavity and the tube clamped for 3 hours. Response was assessed by clinical outcome, measurement of drain output after unclamping and subsequent chest radiography and serial chest ultrasounds. Results: Streptokinase enhanced drainage in all patients with complete resolution of Empyema in 13 patients. Two patients with thickened visceral pleura following empyema drainage were referred to thoracic surgeon for decortication. The number of instillations of Streptokinase per patient ranged from 1 to 3 and the volume of drained empyema fluid ranged from 60 ml to 600 ml per patient. Streptokinase was well tolerated in all patients. Conclusion: Intrapleural Streptokinase is a safe and effective means of increasing the tube drainage in multiloculated Empyema without causing systemic fibrinolysis.Key Words: Streptokinase, Multiloculated Empyemas, Fibrinolysis. 


Hippocrates. Genuine works of Hippocrates. Translated by Anderer F. London: Sydenham Society, 1847.

Lemmer JH, Botham MJ, Orringer MB. Modern management of adult thoracic empyema. J Thorac Cardiovasc Surg 1985; 90:393-419.

Tillett WS, Sherry S. The effects in patients of Streptococcal Fibrinolysin (Strepto-kinase) and Streptococcal Deoxyribon-uclease on fibrinous, purulent and sanguineous pleural exudations. J Clin Invest 1949; 28:173-90

Bergh NP, Ekroth R, Larsson S, Nagy P. Intrapleural Streptokinase in the treatment of haemothorax and empyema. Scand J Cardiovasc Surg 1977; 11:265-8.

Bouros D, Schiza S, Panagou P, Drositis J, Siafakas N. Role of Streptokinase in the treatment of acute loculated parapneumonic pleural effusions and empyema. Thorax 1994; 49:852-5.

Davies RJO, Trail ZC, Gleeson FV. Randomized control trial of intrapleural Streptokinase in community acquired pleural infection. Thorax 1997; 52:416-21.

Muskett A, Burton NA, Karwande SV, Collins MP. Management of refractory empyema with early decortication. Am J Surg 1988; 156:529-32.

Ralph W, Aye MD, Daniel P, Froese MD, Lucious D, Hill MD. Use of purified Streptokinase in empyema and haemo-thorax. The American Journal of Surgery 1991; 161:560-2.

Roupie E, Bouabdullah K, Delclaux C. Intrapleural administration of Streptokinase in complicated purulent pleural effusion: A CT-guided strategy. Int Care Med 1996; 22:1351-3.

Taylor RFH, Rubens MB, Pearson MC, Barnes NC. Intrapleural Streptokinase in the management of empyema. Thorax 1994; 49:856-9.