Chemical pleurodesis with doxycycline 1 g

We evaluated the utility of a single 1-g dose of doxycycline in the treatment of malignant and nonmalignant pleural effusions and refractory pneumothoraces in 27 consecutive patients requiring pleurodesis. After 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 through the chest tube. This was followed by instillation of 100-200 ml of air to facilitate dispersion. The chest tube was removed when the drainage was less than 150 ml/day. Twenty-three of 27 patients were evaluated at 30 days. Six (67%) of the nine patients with pneumothoraces achieved a response, and both patients with nonmalignant pleural effusions had a complete response. Of the 12 patients with malignant pleural effusion, 8 (67%) achieved a complete response, 2 had a partial response, and 2 had no response. Twenty-two (81%) of 27 patients experienced adverse effects with pleurodesis, with pain (81%) and fever (11%) being the most prevalent. In this limited number of patients, doxycycline 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 standard 500-mg dose and with other established agents.