Yes, but just only in the beginning - during first 5-7 days ...

we used it in PICU some years ago but not now  . the reason was that we had some complications with haemothorax. Now we perform early thoracocentesis and if we have a loculated empiema we perform thorachoscopy with excellent results and early discharge.

Rahman et al. Intrapleural Use of Tissue Plasminogen Activator and DNase in Pleural Infection. N Engl J Med. 2011 Aug 11;365(6):518-26

http://www.nejm.org/doi/full/10.1056/NEJMoa1012740?viewType=Print

Here is a review article on the topic as well

Picoolo et al. Intrapleural tissue plasminogen activator and deoxyribonuclease therapy for pleural infection. J Thorac Dis. 2015 Jun; 7(6): 999–1008.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4466425/

MIST 2 trial is best evidence - based on CXR findings, VATS early is best option

There is no real documented research in the literature based on scientific evidence, with 2 groups of patients for the management of  Empyema,surgical or non surgical with instillation of fibrinolytic substance like Streptokinase, or TPA, it is all trail and personal experience with some good results, However , the new modalities with the early intervention of drainage with the use of Thoracoscopy and decortication is much more effective and safer, also we have documented recently even in the late stage III Empyema the Thoracoscopy is feasible and safe option.

Hello Osair,

The debate on this issue is very heated between surgeons and pulmonologists. I can tell you that personally I have nearly abandoned operative drainage except for cases that fail tPA therapy or cases that have trapped lungs and require decortication. These include Empyema in all stages, Parapneumonic effusion, malignant effusion, retained hemothorax as well as other complex effusions. The main complication is bleeding 6.6% but is usually self limited.

CT scan assessment pre and post therapy rather than CXR is preferred. And radiological guidance is the ideal (U/S or CT). Below you can find the details regarding the dosage and protocol.

I hope that helps.

http://bmjopen.bmj.com/content/3/2/e001887.full

Agree with Saleh, interestingly our experience this side of the pond may be different 

.Our surgeons are very supportive of the MIST II based protocols, If I am worried about potential of bleeding I just flip the doses, 4 mg of Tpa and 10 mg of dornase. But do not wait post 7-8 days-> go for surgical solution.

We used actiles for fibrinolyzis at two patients . and it's results was very succesful.But İt is necessary that you look INR before use. if İt is

I Agree with Prof. Trevor that MIST 1 and 2 trials may give a good evidence regarding fibrinolysis in empyema. The Multicenter Intrapleural Sepsis Trial (MIST)-1, the largest randomized placebo-controlled trial of fibrinolytic therapy in pleural infection. Streptokinase offered no benefits in rate of surgery, survival, radiographic outcomes, or length of hospital stay; but induced more adverse events (chest pain, fever, or allergy).   The MIST-2, published in 2011, was a randomized, double-blind, placebo-controlled trial.  Combined intrapleural tPA/DNase resulted in a significantly greater reduction in radiographic pleural opacity, lower surgical referral rate and decreased length of hospital stay compared with placebo. The primary outcome was the absolute change in the pleural opacity on a frontal chest radiograph between days 1 and 7. The mean (SD) reduction in pleural opacity was greater with tPA/DNase than with placebo: expressed as 29.5% (23.3) vs. 17.2% (19.6) of the hemithorax on CXR. In contrast, tPA or DNase alone did not improve radiographic clearance.