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The management of empyema always involves draining the infected pleural fluid. In some cases, use of a chest tube alone is adequate; in others, surgery is required. Intrapleural instillation of fibrinolytics, such as streptokinase (SK), has long been used to break down loculations and improve drainage. Previous studies have shown that fibrinolytic therapy is safe, increases the volume of fluid drained, and may improve clinical outcome. To determine whether it reduces the need for surgery and improves outcome, researchers at a South African hospital conducted a randomized, placebo-controlled trial among 44 patients admitted with pneumonia and either empyema (frank pus in the pleural space) or a complicated parapneumonic effusion (intrapleura…