Livingston MH, Mahant S, Connolly B, et al. - Researchers investigated the effectiveness of intrapleural tissue plasminogen activator (tPA) and DNase vs tPA and placebo at reducing hospital length of stay in children with pleural empyema. In this multicenter, parallel-group, placebo-controlled, superiority randomized clinical trial, randomization was done of 97 children who were diagnosed as having pleural empyema requiring drainage aged 6 months to 18 years treated at 6 tertiary Canadian children’s hospitals. Chest tube insertion and 3 daily administrations of intrapleural tPA, 4 mg, followed by DNase, 5 mg (intervention group), or 5 mL of normal saline (placebo; control group) were performed in participants. Outcomes revealed no significant differences between those treated with tPA and DNase and those treated with tPA and placebo. Thus, the use of chest tube insertion and intrapleural fibrinolytics alone should be supported as first-line treatment for pediatric empyema by guidelines.