Skip to main content
The Egyptian Journal of Bronchology
Download PDF

Doxycycline poudrage in pleurodesis of malignant pleural effusion: a novel modality for an old agent

Egyptian Journal of Bronchology volume 11, pages 7–10 (2017)Cite this article

Abstract

Context

Malignant pleural effusion is a common presentation of several malignancies. Chemical pleurodesis is important in its management, but no consensus exists on the optimal agent or methods of pleurodesis.

Aim

This work aimed to evaluate the outcome of oral doxycycline capsules in a poudrage form through a medical thoracoscope as a therapeutic approach for pleurodesis in patients with malignant pleural effusion.

Setting and design

This study was a prospective quasiexperimental one.

Patients and methods

This prospective quasiexperimental study was conducted on 70 patients with metastatic pleural effusion. They underwent pleurodesis with thoracoscopic doxycycline poudrage.

Results

The success of doxycycline powder poudrage was complete in 75.7% of cases and partial in 10% of cases; however, failure was observed in 14.3%. Thus, total success rate was 85.7%. As regards complications, they were irrelevant; pain was the predominant feature in 81.4% of cases, fever in 11.4% of cases, and empyema in only 4.3% of cases.

Conclusion

Using oral doxycycline with thoracoscopic poudrage yielded a remarkable success rate and may alternate the need for talc powder with less complications and more safety.

References

  1. Antony VB, Loddenkemper R, Astoul P, Boutin C, Goldstraw P, Hott J, et al. Management of malignant pleural effusions. Eur Respir J 2001; 18:402–419.

    Article  CAS  Google Scholar 

  2. Antunes G, Neville E, Duffy J, Ali N, Pleural Diseases Group, Standards of Care Committee, British Thoracic Society. BTS guidelines for the management of malignant pleural effusions. Thorax 2003; 58Suppl 2: ii29–ii38.

    Article  Google Scholar 

  3. Sahn SA. Malignant pleural effusions. In: Fishman AP, Elias JA, Fishman JA, Grippi MA, Senior RM, Pack AI, editors. Pulmonary disease and disorders. 3rd ed. New York, NY: McGraw-Hill; 1998. 1429–1438.

    Google Scholar 

  4. Reddy C, Ernst A, Lamb C, Feller-Kopman D. Rapid pleurodesis for malignant pleural effusions: a pilot study. Chest 2011; 139:1419–1423.

    Article  Google Scholar 

  5. Patz EF Jr, McAdams HP, Erasmus JJ, Goodman PC, Culhane DK, Gilkeson RC, Herndon J. Sclerotherapy for malignant pleural effusions: a prospective randomized trial of bleomycin vs doxycycline with small-bore catheter drainage. Chest 1998; 113:1305–1311.

    Article  CAS  Google Scholar 

  6. Mourad IA, Abdel Rahman AR, Aziz SA, Saber NM, Fouad FA. Pleurodesis as a palliative treatment of advanced lung cancer with malignant pleural effusion. J Egypt Natl Canc Inst 2004; 16:188–194.

    PubMed  Google Scholar 

  7. Kennedy L, Sahn SA. Talc pleurodesis for the treatment of pneumothorax and pleural effusion. Chest 1994; 106:1215–1222.

    Article  CAS  Google Scholar 

  8. Lee YC, Baumann MH, Maskell NA, Waterer GW, Eaton TE, Davies RJ, et al. Pleurodesis practice for malignant pleural effusions in five English-speaking countries: survey of pulmonologists. Chest 2003; 124:2229–2238.

    Article  Google Scholar 

  9. Heffner JE, Standerfer RJ, Torstveit J, Unruh L. Clinical efficacy of doxycycline for pleurodesis. Chest 1994; 105:1743–1747.

    Article  CAS  Google Scholar 

  10. Porcel JM, Salud A, Nabal M, Vives M, Esquerda A, Rodríguez-Panadero F. Rapid pleurodesis with doxycycline through a small-bore catheter for the treatment of metastatic malignant effusions. Support Care Cancer 2006; 14:475–478.

    Article  Google Scholar 

  11. Elnady M, Sakr A. Safety and efficacy of pleurodesis with thoracoscopic doxycycline poudrage in malignant pleural effusion. Eur Respir J 2011; 38:55.

    Google Scholar 

  12. Hatata E, Daabis R, ElSabaa B, Baess A, Abd El-Rahman I. Thoracoscopic pleurodesis using doxycycline poudrage in malignant pleural effusion. Chest 2016; 149(4_S):A437.

    Article  Google Scholar 

  13. Diacon AH, Wyser C, Bolliger CT, Tamm M, Pless M, Perruchoud AP, Solèr M Prospective randomized comparison of thoracoscopic talc poudrage under local anesthesia versus bleomycin instillation for pleurodesis in malignant pleural effusions. Am J Respir Crit Care Med 2000; 162(Pt 1):1445–1449.

    Article  CAS  Google Scholar 

  14. Hartman DL, Gaither JM, Kesler KA, Mylet DM, Brown JW, Mathur PN. Comparison of insufflated talc under thoracoscopic guidance with standard tetracycline and bleomycin pleurodesis for control of malignant pleural effusions. J Thorac Cardiovasc Surg 1993; 105:743–747 discussion 747–748.

    Article  CAS  Google Scholar 

  15. Statement of the American Thoracic Society. Management of malignant pleural effusions. Am J Respir Crit Care Med 2000; 162:1987–2001

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chest Medicine, Faculty of Medicine, Mansoura University, Mansoura, 35116, Egypt

    Tamer A. Elhadidy (MD) & Ahmed M. Abumossalam

  2. Chest Department, Radiotherapy, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Mohamed S. Elashry

Authors
  1. Tamer A. Elhadidy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmed M. Abumossalam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohamed S. Elashry
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tamer A. Elhadidy.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elhadidy, T.A., Abumossalam, A.M. & Elashry, M.S. Doxycycline poudrage in pleurodesis of malignant pleural effusion: a novel modality for an old agent. Egypt J Bronchol 11, 7–10 (2017). https://doi.org/10.4103/1687-8426.199001

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1687-8426.199001

Keywords

  • doxycycline poudrage
  • malignant pleural effusion
  • pleurodesis
  • thoracoscopy