Tissue plasminogen activator as adjunctive therapy of empyema in a child

Pleural effusions and empyemas may complicate 20-57% of bacterial pneumonia s. Clinical experience supports the use of fibrinolytic agents as a means o f dissolving fibrin. releasing loculations and adhesions, thereby allowing for free drainage via thoracostomy tubes. Currently available thrombolytic agents include urokinase, tissue plasminogen activator (TPA), and streptoki nase. Due to manufacturer-related issues, the supply of urokinase has becom e somewhat limited while streptokinase has the potential for allergic react ions in pediatric patients. The authors report the use of TPA as an adjunct to other therapies for treatment of empyema in a 6-year-old boy with pneum ococcal pneumonia.