PURPOSE: Evaluate safety, side-effects, and efficacy of low-dose doxycycline coupled with low-dose talc for thoracoscopic pleurodesis.
METHODS: Over 2 years, all pleuroscopic pleurodesis was performed with talc plus doxycycline as the sclerosing agents. Doses of doxycycline (250 mg) and talc (2.5 grams) were half the “usual” doses. This was a retrospective review of serial cases. Demographics, complications, and efficacy were reviewed.
RESULTS: 33 cases were identified (20 women, 13 men, average age 64 years,21 inpatients and 12 outpatients). The indications were bronchopleural fistula or recurrent pneumothorax in 4 patients and recurrent or persistent symptomatic pleural effusion in 29 patients. No immediate peri-operative complications were noted. Average chest tube duration was 4.2±2.6 days. Total drainage averaged 880 cc. LOS after the procedure in the outpatient group was 4.8±3.1 days. Post-operatively, 11 patients (33%) reported persistence or worsening dyspnea, and only 2 developed respiratory distress. Neither of these 2 patients had any parenchymal changes on chest radiology, or required ventilatory support. One was monitored in the ICU for 2 days. 3 patients developed post-operative fever. Average post-op Tmax was 99 ±2.3. Eighteen patients (54%) reported chest pain. No empyema noted. Follow-up imaging was available for 30 patients an average of 3.9 months post-operatively. 19 patients (63%) had complete pleurodesis, 4 patients (14%) had partial pleurodesis, and 7 (23%) failed. In no case did follow-up imaging at any time demonstrate new ARDS-like infiltrates.
CONCLUSION: We have been using talc plus doxycyline in doses lower than traditionally used for each agent alone for pleuroscopic pleurodesis for 2 years. The rationale is to avoid side-effects known to occur with each agent by minimizing dosing. Our success rate has matched that of the literature for talc alone. Our side-effect profile has been reasonable. No severe sequelae were observed.
CLINICAL IMPLICATIONS: The combination of low-doses doxycycline and low-dose talc appears to be a safe and rational approach to pleuroscopic pleurodesis in human beings. A prospective trial comparing talc alone in higher doses to our combination seems warranted.
DISCLOSURE: Wissam Abouzgheib, No Financial Disclosure Information; No Product/Research Disclosure Information