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

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.