TY - JOUR T1 - An international survey on the use of intrapleural tPA/DNase therapy for pleural infection JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00590-2021 SP - 00590-2021 AU - Estee P. M. Lau AU - Matin Eshraghi AU - Kirstie Dootson AU - Cindy Yeoh AU - Wint Ywe Phu AU - Y. C. Gary Lee AU - Natalia D. Popowicz Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/early/2021/11/18/23120541.00590-2021.abstract N2 - Introduction Intrapleural tissue plasminogen activator (tPA) combined with human recombinant DNase (DNase) could be an effective alternative to surgery in managing pleural infection as demonstrated in the Multi-centre Intrapleural Sepsis Trial (MIST)-2. However, the optimal delivery regime is still unknown. The aim of this survey is to identify the current practice of tPA/DNase use by physicians with published interests in pleural infection, and their opinions on dose de-escalation of tPA/DNase therapy.Methods Potential participants were identified using four search strategies. Only practicing physicians who are managing patients with pleural infections and are either actively involved in pleural research and publications, or members of relevant pleural disease guideline panels at the time of survey were included.Results An invitation email with the questionnaire was sent to 102 participants of which 49 (48%) responded. Most respondents (90%, n=44) have used tPA/DNase to manage pleural infection but the dosing and delivery regimens employed varied. Many (86%, n=38/44) respondents have used 10 mg tPA, while 73% (n=32), 16%, (n=7) and 9% (n=4) have used 5 mg, 2.5 mg and 1 mg doses respectively. Most respondents instilled tPA/DNase concurrently (61%, n=27) and routinely administered 6 doses of tPA/DNase (52%, n=23) twice daily (82%, n=36). Respondents would consider using a lower starting dose of tPA (with the possibility of escalation if clinically needed) if 80% [IQR 50–80] of patients could be successfully treated at that dose.Conclusion This survey observed a large variation in the current treatment protocol of intrapleural tPA/DNase therapy worldwide and the need for more data on this subject.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Estee P. M. Lau has nothing to disclose.Conflict of interest: Matin Eshraghi has nothing to disclose.Conflict of interest: Kirstie Dootson has nothing to disclose.Conflict of interest: Cindy Yeoh has nothing to disclose.Conflict of interest: Wint Ywe Phu has nothing to disclose.Conflict of interest: Y. C. Gary Lee is an honorary consultant to Lung Therapeutics Ltd.Conflict of interest: Natalia D. Popowicz have reported that no potential conflicts of interest exist with any companies/organisations whose products or services may be discussed in this article ER -