CHEMICAL PLEURODESIS WITH DOXYCYCLINE 1 G

We evaluated the utility of a single 1-g dose of doxycycline in the tr eatment of malignant and nonmalignant pleural effusions and refractory pneumothoraces in 27 consecutive patients requiring pleurodesis. Afte r the evacuation of all retained air or fluid, and premedication with intravenous narcotic analgesics and intrapleural lidocaine 200 mg, the patients received doxycycline 1 g in 50 ml normal saline instilled th rough the chest tube. This was followed by instillation of 100-200 ml of air to facilitate dispersion. The chest tube was removed when the d rainage was less than 150 ml/day. Twenty-three of 27 patients were eva luated at 30 days. Six (67%) of the nine patients with pneumothoraces achieved a response, and both patients with nonmalignant pleural effus ions had a complete response. Of the 12 patients with malignant pleura l effusion, 8 (67%) achieved a complete response, 2 had a partial resp onse, and 2 had no response. Twenty-two (81%) of 27 patients experienc ed adverse effects with pleurodesis, with pain (81%) and fever (11%) b eing the most prevalent. In this limited number of patients, doxycycli ne 1 g appeared to be safe and effective for the treatment of pleural effusions and pneumothoraces. The 1-g dose must be compared with the s tandard 500-mg dose and with other established agents.