Chest
Clinical InvestigationsSystemic Absorption of Tetracycline and Lidocaine following Intrapleural Instillation
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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Cited by (32)
Thoracoscopic bullectomy and tetracycline pleurodesis for the treatment of spontaneous pneumothorax
1995, Respiratory MedicineManagement of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010
2010, ThoraxCitation 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.
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.