saline + alteplase + dornase alfa

This investigational combination regimen consists of intrapleural saline, alteplase (a recombinant tissue plasminogen activator), and dornase alfa (a recombinant human deoxyribonuclease). It is being evaluated by Dartmouth-Hitchcock Medical Center in the FLO Trial (Step-Wise Escalation for Pleural Infection) for patients with complicated parapneumonic effusion or empyema. The regimen follows a step-wise escalation strategy: it begins with intrapleural saline instillation to facilitate drainage, followed by the administration of alteplase and dornase alfa if the initial flush is insufficient. Alteplase acts as a fibrinolytic agent that targets fibrin clots and loculations within the pleural space, while dornase alfa degrades extracellular DNA to reduce the viscosity of infected pleural fluid. Together, these agents facilitate the drainage of infected collections and aim to reduce the necessity for surgical intervention.

Brand names

ActivasePulmozyme

Other names

intrapleural saline + intrapleural alteplase + dornasetPA + DNaseintrapleural tPA + DNasealteplase + dornase alfa