Treatment of malignant pleural effusion with doxycycline

Pleurodesis for effective control of malignant pleural effusion can be induced with various methods and agents. In 18 patients with histologically or cytologically proven malignant pleural effusion, 500 mg doxycycline hydrochloride diluted in 30 ml of saline was instilled into the emptied pleural space. Tube drainage was performed using suction or gravity. More than one doxycycline instillation was required in 13 cases. Serial chest radiography showed the response to be complete in 11 of the 18 patients and partial in four, while three did not respond. There was no difference between the results obtained with the two drainage systems. In all of the complete responders who died there was no sign of reaccumulated pleural effusion at terminal admission, despite clinical evidence of systemic tumor progression. Three patients--all with breast carcinoma--are alive after 5-27 months, two as complete responders and one as partial responder. The most common side effect was pleuritic pain, defined as significant if narcotic analgesics were required. A moderate febrile reaction appeared in four patients during the first 24 hours post-instillation. The study showed doxycycline to be an effective sclerosing agent for inducing pleurodesis, with acceptable adverse effects.