The Administration of rt-PA (Activase®) for the Treatment of Empyema in an Adult Patient

The administration of various fibrinolytic agents for the treatment of empyema has been reported in past studies. Most of the current literature has shown favorable outcomes in terms of increased tube drainage, improved chest radiography, and reduction in surgical intervention. However, a randomized controlled trial that compared streptokinase to placebo showed no significant reduction in mortality. To date, there have been no randomized controlled trials evaluating the safety, efficacy, and administration of recombinant tissue plasminogen activator for the treatment of empyema in the adult population. The authors report the use of a 10 mg daily dose of intrapleural recombinant tissue plasminogen activator for 6 days in a 57-year-old, white, male patient with empyema that was unresponsive to antibiotic therapy and chest tube drainage. They conclude that intrapleural administration of recombinant tissue plasminogen activator in conjunction with antibiotic therapy for the treatment of empyema in this patient resulted in increased chest tube drainage and provided complete resolution of all signs and symptoms of his infection.