Intra-pleural tissue plasminogen activator and deoxyribonuclease: An alternative treatment option for pleural infections in specific populations

  • Rita Medrano
  • Audra Schwalk
  • Ebtesam Islam

Abstract

Pleural infections can be associated with significant morbidity and mortality. Systemic
antibiotics and drainage are the standard treatment, but some patients require surgical
intervention for complete resolution. For unsuitable surgical candidates, the intra-pleural
administration of tissue plasminogen activator and deoxyribonuclease (tPA/DNase) is a
potential treatment option for loculated effusions. We present a case of loculated empyema
successfully treated with a 3-day course of once daily intra-pleural administration of tPA/
DNase. Considering the frailty of our patient, we choose the once daily tPA/DNase due to
concerns about potential complications, such as increased risk of bleeding. The published trial
evidence and administration regimens of intra-pleural tPA/DNase are also discussed.

References

Rahman NM, Maskell NA, West A, et al. Intra-pleural use of

tissue plasminogen activator and DNase in pleural infection.

N Engl J Med 2011;365:518–526.

Rahman NM, Kahan BC, Miller RF, et al. A clinical score

(RAPID) to identify those at risk for poor outcome at presentation

in patients with pleural infection. Chest 2014;145:

–855.

Maskell NA, Davies CW, Nunn AJ, et al. for the First Multicenter

Intra-Pleural Sepsis Trial (MIST1) Group. U.K. Controlled

trial of intra-pleural streptokinase for pleural infection.

N Engl J Med 2005;352:865–874.

Piccolo F, Popowicz N, Wong D, et al. Intrapleural tissue plasminogen

activator and deoxyribonuclease therapy for pleural

infection. J Thoracic Disease 2015;7(6):999–1008.

Mehta H J, Biswas A, Penley A M, et al. Management of

intra-pleural sepsis with once daily use of tissue plasminogen

activator and deoxyribonuclease. Respiration 2016; 91:101–106.

Published
2018-07-20
How to Cite
Medrano, R., Schwalk, A., & Islam, E. (2018). Intra-pleural tissue plasminogen activator and deoxyribonuclease: An alternative treatment option for pleural infections in specific populations. The Southwest Respiratory and Critical Care Chronicles, 6(25), 38-41. https://doi.org/10.12746/swrccc.v6i25.483