Bilateral thoracic empyema is a rare clinical entity particularly when presented as an initial clinical manifestation. Antibiotic therapy with intercostal thoracostomy drainage tube of the infected pleural space in complicated parapneumonic empyema may not be adequate in many conditions due to multiloculation and adhesion. We describe in this case a previously healthy middle aged male, presented with a bilateral thoracic empyema that was treated initially with antibiotics and intercostal drainage tube without optimal drainage results. The administration of twice daily intrapleural streptokinase prolonged for the duration of more than 10 days proved to be safe and effective as an alternative line of management in such a clinical condition.