Is tPA/DNase Effective Routine Initial Therapy for Pleural Empyema?

Following the validation of intrapleural tPA/DNAse therapy for the treatment of pleural empyema by the MIST-2 trial, the medical community has shifted the management approach for empyema, favoring less aggressive alternatives to surgery with good results. Our comprehensive literature review revealed that the treatment of empyema with a tPA/DNase regimen has been proven effective in the management of stage 2 empyema, decreasing the need for surgical intervention. However, direct comparative analyses between this treatment strategy and surgery have not yielded statistically significant differences.