Role of Chymotrypsin in Management of Moderate Parapneumonic Pleural Effusion in Children

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.