Is streptokinase fibrinolysis the best treatment for empyema in pediatric patients? And must we tap every cirrhotic patient with bilateral pleural effusion?

as well as shorter overall hospitalization duration. In a study in 1949, Tillett and Sherry [6] reported the use of a mixture of streptokinase and streptodornase for intrapleural fibrinolysis. Purified streptokinase was available in the 1960s, resulting in an improved safety profile [7]. Due to concerns about the antigenicity of streptokinase, urokinase was introduced in 1987 and became the most frequently used agent for fibrinolysis. Yao and coresearchers [8] demonstrated the safety and efficacy of streptokinase pleural fibrinolysis in a pediatric population. Levy Faber and co-authors [5] concluded that streptokinase pleural fibrinolysis could obviate the need for surgery in most cases. The authors stress that the attempt be made early on, when complicated parapneumonic effusion is first diagnosed. Treatment of empyema can be summarized as appropriate antibiotic therapy combined with medical or surgical drainage of the pleural space, management of any underlying factors, with early use of intrapleural streptokinase or urokinase. Such treatment can obviate the need for surgery in most cases of empyema, leaving the complicated chronic disease cases for surgery. In the spectrum of pleural infectious disease, not much attention is paid to spontaneous bacterial empyema, defined as the spontaneous infection of the pleural fluid, which represents a distinct complication of hepatic hydrothorax. The pathogenesis of SBEM1 remains unclear. It