A Cochrane review [Abstract] 1 included 7 studies with a total of 761 subjects having presented with parapneumonic effusion only (5 studies) or with parapneumonic effusions and empyema (2 studies). The only consistent end points in all trials were treatment failure, as gauged by the requirement for additional intervention including surgery or death. In studies where patients had either loculation and empyema, there was no significant difference in the risk of death with fibrinolytics (RR 1.08; 95% CI 0.69 to 1.68). When treatment failure was considered as surgical intervention, fibrinolytics reduced the risk of this outcome (RR 0.63; 95% CI 0.46 to 0.85), but there is discordance between earlier positive studies and the more recent negative study by Maskell.
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies) and by imprecise results (limited study size for each comparison).
Primary/Secondary Keywords