Systemic Absorption of Tetracycline and Lidocaine following Intrapleural Instillation

doi:10.1378/chest.94.5.960

Chest

Volume 94, Issue 5, November 1988, Pages 960-963

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Seven patients with symptomatic pleural effusions (six) and recurrent pneumothorax (one) underwent attempted pleurodesis using tetracycline. Lidocaine (150 mg), followed immediately by tetracycline (20 mg/kg), was instilled into the pleural space through a chest tube. Venous blood was obtained at 0, 15, 30, 60, and 120 minutes following instillation in order to determine concentrations of lidocaine and tetracycline. The mean peak serum concentration of lidocaine was 1.3μ/ml ± 0.4μg/ml (mean ± SE) (range, 0.3μg/ml to 3.2μg/ml), and the mean time to peak serum concentration of lidocaine was 86 ± 13 minutes. The mean peak serum concentration of tetracycline was 3.6μg/ml ± 0.9μg/ml (range, 1.0μg/ml to 5.0μg/ml), and the mean time to peak serum concentration of tetracycline was 96 ± 16 minutes. Therapeutic serum concentrations of lidocaine were found in four of the seven patients and therapeutic serum levels of tetracycline in four of five patients. With systemic absorption of lidocaine and tetracycline following intrapleural instillation, patients are at risk for potential toxic effects. If lidocaine is used in a dosage of less than 3 mg/kg, toxic levels of the drug are unlikely to occur. Furthermore, use of tetracycline or lidocaine in pleurodesis is contraindicated in patients with known sensitivity to the drugs.

Section snippets

MATERIALS AND METHODS

Seven patients (six male patients and one female patient) underwent intrapleural instillation of tetracycline for symptomatic, recurrent pleural effusions or pneumothoraces. Five patients had effusions associated with malignancy, one patient had an undiagnosed exudative effusion, and one patient had recurrent pneumothoraces. Four of the effusions associated with malignancy were exudates, and one was a transudate. A successful pleurodesis was defined as the prevention of accumulation of

RESULTS

Pleurodesis was successful in three of the seven patients, one with a transudative effusion, one with adenocarcinoma of the lung, and one with recurrent pneumothorax (follow-up, one year). Pain associated with the instillation of tetracycline was severe only in the patient with pneumothorax.

Pleural fluid cytology was negative in four and pleural biopsy negative in two of the five patients with malignancy, suggesting that the effusions were due to impaired lymphatic drainage of the pleural space.

DISCUSSION

Tetracycline is semisynthetically produced from chlortetracycline elaborated by Streptomyces aureofaciens. Following a single oral dose of 500 mg of tetracycline, peak serum concentration occurs within three hours and averages 3.5μg/ml to 4μg/ml; minimum inhibitory concentrations range from 1μg/ml to 5μg/ml.⁹ In the present study, four of five patients had serum levels in the therapeutic range. Chest pain is the most common adverse effect following instillation into the pleural space and

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Citation Excerpt :
The issue of safety has been highlighted in two studies. Wooten et al60 showed that the mean peak serum concentration of lidocaine following 150 mg of intrapleural lidocaine was 1.3 mg/ml, well below the serum concentration associated with central nervous system side effects (ie, >3 mg/ml). In an earlier study of 20 patients, larger doses of lidocaine were necessary to achieve acceptable levels of local anaesthesia.

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Supported by an institutional research grant from the Medical University of South Carolina.

Presented in part at the Annual Meeting, American Thoracic Society, New Orleans, May 12, 1987.

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Chest

Clinical InvestigationsSystemic Absorption of Tetracycline and Lidocaine following Intrapleural Instillation

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

Chest

Chest

Chest

Intrapleural tetracycline for control of malignant pleural effusions

South Med J

Intrapleural tetracycline in malignant pleural effusions

Cancer

Pleural reaction to irritants

Acta Chir Scand

Intrapleural heparin prevents tetracycline-induced pleural symphysis

Clin Res

Enhanced fibrinolysis alters tetracycline-induced pleural symphysis

Clin Res

The effects of common sclerosing agents on the rabbit pleural space

Am Rev Respir Dis

Clinical Investigations
Systemic Absorption of Tetracycline and Lidocaine following Intrapleural Instillation