Inclusion Criteria:  adult patient with age more than 17 year old evidence of complex parapneumonic effusion or empyema; with poor pleural fluid drainage of ≤150 mL after 24 hours of insertion of chest drain clinical evidence of infection such as fever and or elevated C-reactive protein (CRP) or white-cell count complex pleural effusion proven by ultrasound pleural fluid analysis that fulfilled at least one of the characteristics: frank pus, exudative nature (according to light's criteria), gram stain or culture positive, lactate dehydrogenase (LDH) > 1000 U/L, pH < 7.2 and/or glucose level < 3.3mmol/L  Exclusion Criteria:  known allergy to pulmozyme or alteplase acute stroke, active bleeding diathesis major surgery in past 5 days previous pneumonectomy on the infected side bronchopleural fistula pregnancy coagulopathy (INR > 2, APTT >100, platelet count < 50,000 cells)