Intrapleural administration of Pulmozyme for pleural empyema

Empyema is a severe complication of different diseases and traumas. Management of this complication is difficult and should comprise general and local procedures. The general procedure is mainly based on administering wide-spectrum antibiotics. Local management depends on general condition, but in all cases the essential procedure is inserting a drain into the pleural cavity and evacuation the pus. Sometimes pus is very thick and its evacuation and re-expansion of the lung is rather impossible. In these patients surgical procedures are required. The use of intrapleural enzymes to aid drainage was first described in 1949 by Tillett and Sherry using a mixture of streptokinase and streptococcal DNase (deoxyribonuclease).1 In recent years purified streptokinase has come into widespread use, but recent studies suggest that it has no effect on pus viscosity. DNase reduces pus viscosity and may be more useful in treatment.2 We report a case of intrapleural administration of Pulmozyme (alfa dornase – deoxyribonuclease (HOFFMANN-LA ROCHE AG) in dosage 2×2,5 mg with a good effect caused by changes in pus viscosity.