Role of Chymotrypsin in Management of Moderate Parapneumonic Pleural Effusion in Children
Rawan Mohamed Eldeeb *
Department of Pediatric, Faculty of Medicine, Tanta University, Egypt.
Md Ahmed Abd El Basset Abo El Ezz
Department of Pediatric, Faculty of Medicine, Tanta University, Egypt.
Md Mohamed Adel Eltomey
Department of Radiology, Faculty of Medicine, Tanta University, Egypt.
Md Mohamed Basiony Hamza
Department of Pediatric, Faculty of Medicine, Tanta University, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Aims: To show the benefit of chymotrypsin as an adjuvant therapy in cases of moderate parapneumonic pleural effusion in children.
Study Design: Randomized controlled trial.
Place and Duration of Study: Pulmonology Unit, Pediatric Department and Radiology Department, Tanta University Hospital, Egypt between Februray, 2019 to Februray, 2020.
Methodology: Subjects comprised of 60 children randomized into three groups 20 children each (41 males, 19 females; age range 1-14 years) with moderate parapneumonic pleural effusion by chest ultrasound. Clinical as well as complete blood count, C-reactive protein and chest ultrasonography at time of presentation, after one week (first end point) and after two weeks (second end point). Management with antibiotics, analgesics, antipyretics, chest tube insertion and oral chymotrypsin in group 2 and intramuscular chymotrypsin in group 3.
Results: There was statistically significant decrease in fluid thickness by chest u/s (mm) in group 2 (Mean ±SD= 6.400±3.872) and group 3 (Mean ±SD= 6.150±2.720) after one week and after two weeks group 2 (Mean ±SD= 15.3±4.658) while group 3 (Mean ±SD= 3.3±1.559) in comparsion to group 1 after one week (Mean ±SD= 16.100±10.351) and after two weeks (Mean ±SD= 11.35±7.066) ( P < 0.001), duration of hospitalization (days) and chest tube (days) were statistically significant lower in group 2 (Mean±SD= 15.200±4.112 ), (Mean±SD= 9.100±2.808) respectively and group 3 (Mean±SD= 14.050±3.300), (Mean±SD= 7.400±1.698 ), in relative to group 1 (Mean±SD= 18.65±3.329 ), (Mean±SD= 9.85±3.265 ), (P <0.001, P=0.017 respectively) and percentage of decortication was statistically significant lower in group 2 and 3 in relative to group 1. (P =0.017).
Conclusion: Chymotrypsin has an adjuvant role in management of moderate parapneumonic pleural effusion evidenced by earlier recovery less hospital stay, derease in chest tube insertion and need for decortication and intramuscular chymotrypsin injection has better effect than oral chymotrypsin in moderate parapneumonic pleural effusion.
Keywords: Parapneumonic, chymotrypsin, fibrinolytics.