Study Compares Treatments for Kids' Lung Infection

Cheaper enzyme therapy equals surgery for pneumonia complication, researchers report

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TUESDAY, July 18, 2006 (HealthDay News) -- Doctors say they've come up with a cheaper but equally effective means of battling an infection of the lining of the lungs in children.

The treatment, which involves the use of enzyme urokinase to help drain the chest, costs 25 percent less than video-assisted thorascopic surgery and should be the primary treatment for this condition, known as empyema, according to a British team reporting in the July issue of the American Journal of Respiratory and Critical Care Medicine.

Both treatments provide equal clinical results, said the researchers, who studied 60 children with empyema. The condition involves pus from pneumonia infecting the pleural membrane that lines the lung walls.

For this study, 30 of the children (average age 3.5 years) were treated with chest drainage using intrapleural urokinase and the other 30 children underwent video-assisted thorascopic surgery.

"The aim of treatment is empyema is to sterilize the pleural cavity, reduce fever and ensure the full expansion of the lung so it can return to normal function," researcher Dr. Samantha Sonnappa, of the Portex Respiratory Unit at the Institute of Child Health in London, said in a prepared statement.

"Our study is the first randomized prospective trial to compare chest drain against primary video-assisted thoracopic surgery for the treatment of empyema in children."

The two treatment groups had no significant clinical differences in terms of length of hospital stay, failure rate of the procedure, or radiologic outcome at six months after treatment.

"An important observation is that video-assisted thorascopic surgery is $2,250, or 25 percent, more expensive than intrapleural urokinase at our center without including start-up costs for the provision of surgery," Sonnappa said.

An accompanying editorial in the same issue of the journal expressed some concerns about the study.

"One would certainly say that, on a cost basis, urokinase is the better choice if the therapies are equivalent in every other way," wrote Dr. Julian Allen and Dr. Peter Mattei of the Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine.

But they noted that study data seems to suggest that children in the surgical study group may have had slightly worse disease than those receiving urokinase, potentially skewing the results. In addition, certain clinical factors were not reported by the study authors, which means there could have been even more differences between the two treatment groups.

"Other important outcomes include the following: the amount of pain associated with the intervention and long-term physiologic outcomes such as pulmonary function and exercise tolerance. These variables are certainly more important than a $2,000 difference in cost," the editorial authors wrote.

More information

The U.S. National Library of Medicine has more about empyema.

SOURCE: American Thoracic Society, news release, July 15, 2006

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