THE ROLE OF INTRA PLEURAL STREPTOKINASE IN TREATING COMPLICATED PLEURAL EFFUSION AND EMPYEMA

Abstract

Background: Complicated parapneumonic effusions (CPE) and empyema are severe complications of pneumonia, often requiring prolonged hospitalization or surgical intervention. Intrapleural streptokinase (IPSTK) has shown promise in enhancing pleural fluid drainage and reducing surgical needs, but its efficacy in resource-limited settings remains underexplored. This study evaluates IPSTK’s role in managing CPE and empyema in a Pakistani population.

Methods: Randomized controlled trial was done at Pak Emirates Military Hospital, Rawalpindi, Pakistan, between July to September 2025. Sixty adults aged 18–80 years with imaging-proven CPE or empyema were randomized (1:1) into Group A (conservative management: antibiotics and chest tube drainage) or Group B (conservative management with the addition of IPSTK, 250,000 IU per day for 3 days). Outcomes were treatment success (resolution of symptoms, drainage <50 ml/24 hours, and radiological improvement), volume of drainage, hospital stay, surgical referrals, and adverse events. Data were analyzed with IBM SPSS version 25 using Chi-square tests for outcomes categorized and t-tests for continuous data (p≤0.05 considered significant).

Results: Group B had greater mean drainage volume (1850 ± 420 ml vs. 1420 ± 380 ml, p<0.001) and lower hospital stay (8.4 ± 2.1 days vs. 11.2 ± 2.8 days, p<0.001) than Group A. Success of treatment was greater in Group B (90.0% vs. 80.0%, p=0.22), and surgical referrals were fewer (6.7% vs. 16.7%, p=0.23), although not significant. Benefits were most significant in patients under 60 years (92.3% vs. 73.9%, p=0.04) and in patients with no comorbidities (93.3% vs. 71.4%, p=0.03). Minor bleeding was noted in 6.7% of Group B patients, without any severe adverse events.

Conclusion: IPSTK has a marked beneficial effect on pleural fluid drainage and hospital stay in CPE and empyema, especially among younger, healthier patients, with a good safety profile. These results justify its use in limited resource environments, although larger trials will be required to establish reductions in referral to surgery.