We considered the certainty of the evidence identified comparing fibrinolytic with placebo to vary from moderate (risk of death) to very low (overall treatment failure). We found no clear evidence that any single fibrinolytic was better than another. There was some low-certainty evidence which showed that there may be a risk of more side effects (mostly bleeding) with fibrinolytics but this is uncertain. There was no clear evidence that fibrinolytics changed the risk of death. We found some low-certainty evidence that fibrinolytics moderately reduced the need for surgery. We also included two studies comparing different fibrinolytics with a total of 149 patients and compared these separately. We included 10 studies with a total of 993 patients comparing fibrinolytics with a placebo and compared these to look for differences. We searched for studies up to August 2019. We also wanted to know if one fibrinolytic medicine was more effective than another. We also wanted to see if these medicines reduced the chance of people dying due to these infections whether the fibrinolytic treatment worked overall and whether these medicines caused serious side effects. We wanted to know if fibrinolytics reduced the need for people with infections in the pleural space to have surgery to fix the infection. Fibrinolytic drugs ('clot-busting drugs') may make the infected pleural fluid thinner, less sticky and easier to drain via a chest tube, meaning that surgery may not be needed. If this does not work, then surgery is usually needed to drain the fluid. They are treated by draining the fluid with a tube inserted through the chest into the fluid (a 'chest tube'), along with antibiotics. Empyema and complicated parapneumonic effusion are conditions involving infected fluid gathering between the lung and the chest wall (the pleural space).
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