A new look at an old agent for pleurodesis

Background and objectiveMalignant pleural effusion (MPE) is a common problem in patients with malignancies. Chemical pleurodesis is the most commonly used palliative option. Parenteral tetracycline (TET) and doxycycline (DOX) are cost-effective and safe in producing pleurodesis but mostly unavailable currently. We investigated whether oral doxycycline could produce an efficient and safe pleurodesis as does parenteral doxycycline, which is currently unavailable in many countries.MethodsA prospective study of 24 pleurodesis procedures in 22 patients with malignant pleural effusions were conducted over a 3-year period. All pleurodesis was performed with oral forms of doxycycline as the sclerosing agent, where about 1000 mg of doxycycline was taken and prepared from the oral preparation (vibramycin 100 mg/capsule) and mixed in 50 ml. Physiological saline was then administered via tube thoracostomy. We assessed the success or failure of pleurodesis in addition to the frequency of complications and survival. Post-pleurodesis postero-anterior (PA) radiographs were obtained after tube removal and 30 days following the procedure.ResultsTwenty-two patients were included (6 women, 16 men), the mean age was (62.5 years). Origins of MPE were: lung and pleura 8 (36.4%), breast 2 (9.1%), ovarian 2 (9.1%), digestive 3 (13.6%), lymphoma 3 (13.6%) and unknown 4 (18.2%). No immediate perioperative complications were noted. Chest tube duration averaged 4.2 ± 2.6 days. Immediate postoperative events included chest pain in 10 patients (45.5%), fever in 2 (9.1%) patients, pain and fever in 5 patients (22.7%). Sixteen patients (72.7%) had successful pleurodesis and 6 patients (27.3%) had failed pleurodesis at 1 month.ConclusionsPleurodesis with oral forms of doxycycline dissolved in sterile saline solution have a high success rate with a low incidence of complications and could be a good option as palliative therapy in patients with symptomatic malignant pleural effusions.