Bouros et al,2in a randomized, double-blind study of 31
patients, showed that a 3-day regimen of intrapleural urokinase
(compared with normal saline solution) significantly reduced the length
of hospital stay (13 days vs 18 days, respectively) and the need for
further intervention (13.5% vs 37.5%, respectively, of all patients).
The results of adjunctive treatment with intrapleural streptokinase,
however, have been less impressive. In two controlled studies with a
total of 76 patients, streptokinase failed to significantly reduce the
duration of hospitalization or the need for surgical
drainage.3–4 Moreover, Wait et al,5 in a
randomized, controlled study of 20 patients with multiloculated
parapneumonic effusions and empyema, showed that primary treatment with
VATS resulted in significantly shorter hospital stays and lower costs
than intrapleural streptokinase therapy.