Pleural disease · Pleural infection
U.K. Controlled trial of intrapleural streptokinase for pleural infection
| Design | Randomised, double-blind, placebo-controlled trial |
|---|---|
| Treatment | Intrapleural streptokinase |
| Control | Placebo |
| Population | 427 patients with pleural infection who received streptokinase or placebo |
| Follow-up | 12 months |
| Primary endpoint | Death or need for surgical drainage at 3 months |
| Result | Death or surgery occurred in 64 of 206 (31%) with streptokinase and 60 of 221 (27%) with placebo — relative risk 1.14 (95% CI 0.85 to 1.54, p=0.43), excluding a clinically significant benefit. There was no benefit in mortality, rate of surgery, radiographic outcomes or hospital stay, and serious adverse events were more frequent with streptokinase. |
| Secondary endpoints | Mortality, surgery rate, radiographic outcome, length of stay, serious adverse events |
The intrapleural administration of streptokinase does not improve mortality, the rate of surgery, or the length of the hospital stay among patients with pleural infection.
The trial authors, in the published abstract
A convincing negative that nearly killed intrapleural fibrinolysis altogether. MIST2 rescued the idea by showing that a fibrinolytic works only when combined with DNase — the same investigators, the same question, and a factorial design that explained why the first trial failed.
Maskell NA, Davies CW, Nunn AJ, et al. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 2005 Mar 3;352(9):865-74.