Previously, we have shown rapid and complete dispersion of tetracyclin
e hydrochloride in the pleural space following chest tube instillation
. To assess the clinical relevance of this observation, we randomized
patients with symptomatic pleural effusions to rotation (R) (n = 19) a
nd nonrotation (NR) (n = 21) groups following administration of tetrac
ycline hydrochloride, 20 mg/kg (n = 30); 300 mg of minocycline hydroch
loride (n = 6); and 500 mg of doxycycline hydrochloride (n = 4) throug
h a chest tube. Patients in the R group were maneuvered through six po
sitions for the 2 h that the chest tube remained clamped. The NR patie
nts remained supine for 2 h. Rotation and nonrotation groups were simi
lar in demographics, source of pleural effusion, symptoms, and serum a
nd pleural fluid analyses (all p=NS). A chest radiograph was scored ba
sed on pleural fluid recurrence throughout survival or up to 12 months
. Survival, duration of chest tube instillation, and success of pleuro
desis assessed by radiographic pleural fluid reaccumulation (73.7 vs 6
1.9 percent; R vs NR) were similar (p = NS). Rotational maneuvers appe
ar to offer no benefit to the success of pleural symphysis after intra
pleural instillation of tetracycline class agents.