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ELECTRONIC ARTICLE:
Naomi B. Bishop, Steven Pon, H. Michael Ushay, and Bruce M. Greenwald
Alteplase in the Treatment of Complicated Parapneumonic Effusion: A Case Report
Pediatrics 2003; 111: e188-e190 [Abstract] [Full text] [PDF]
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[Read eLetters] Proven treatments exist for pediatric empyema
Robert Primhak   (17 February 2003)

Proven treatments exist for pediatric empyema 17 February 2003
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Robert Primhak,
Paediatrician
Sheffield Children's Hospital, UK

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Re: Proven treatments exist for pediatric empyema

r.a.primhak{at}sheffield.ac.uk Robert Primhak

Bishop et al describe the previously untried use of intrapleural Alteplase to treat a 16 month old child with a complex parapneumonic effusion. While I recognise that they may have been unaware of the randomised placebo controlled trial of intrapleural urokinase in the management of empyema, published last year1. This trial showed convincing evidence of benefit from urokinase, with few adverse effects. The median length of stay in the treatment group was 7.4 days, which compares favourably to the reported case. The best results have been found using smaller pigtail catheters (e.g. 12 French)(1,2) rather than the 16 French catheter used by Bishop. While it is important to try new treatments for conditions where treatment is ineffective, it is also crucial that these innovations are compared to effective treatments which have been undergone adequate clinical trial.

References 1. Thomson A, Hull J, Kumar M, Wallis C, Balfour Lynn I, et al. Randomised trial of intrapleural urokinase in the treatment of childhood empyema. Thorax 2002;57:343-7. 2. Pierrepoint M, Evans A, Morris S, Harrison S, Doull I. Pigtail catheter drain in the treatment of empyema thoracis. Archives of Disease in Childhood 2002;87:331-2.