The researchers found that the two treatments for empyema (a build-up of pus) in the space surrounding the lungs were about as effective as each other, but concluded that the enzyme treatment was preferable because of its cheaper cost.
The study results appear in the second issue for July 2006 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Dr Samatha Sonnappa, of the Portex Respiratory Unit at the Institute of Child Health in London, and seven associates studied 60 children with empyema, which involves pus from pneumonia infecting the pleural membrane lining the lung walls.
Thirty children were treated with chest drainage using intrapleural urokinase, and 30 underwent video-assisted thorascopic surgery for the problem. The average age of the patients was three and a half.
The pleura is a very thin, transparent membrane that covers the lungs and lines the inside of the chest wall. Empyema occurs when pus from pneumonia or a lung abscess spreads into the pleural space. About 0.6% of childhood pneumonia progresses to empyema.
“The aim of treatment in empyema is to sterilize the pleural cavity, reduce fever and ensure the full expansion of the lung so it can return to normal function,” said Dr Sonnappa. “Our study is the first randomized prospective trial to compare chest drain against primary video-assisted thorascopic surgery for the treatment of empyema in children.”
No significant clinical differences were found between each treatment group in terms of length of hospital stay after intervention, failure rate of the procedure or radiologic outcome at six months after the procedure.