Efficacy of tetracycline pleurodesis for spontaneous pneumothorax (no intervention on lung)
| Study author | Year | Study design | Total number of cases | PSP or SSP? (n) | Intervention (n) | Intervention recurrence rate (95% CI) | Control/reference arm (n)? | Control/reference recurrence rate (95% CI) | Follow-up period (months) | OR (vs control/reference) (95% CI) |
|---|---|---|---|---|---|---|---|---|---|---|
| RCTs—medical | ||||||||||
| Light7 | 1990 | RCT | 229 | PSP (46) SSP (183) | Tetracycline via chest drain (113) | 25.0% (16.2% to 38.0%) | Drainage only (116) | 40.7% (28.0% to 58.7%) | 29–34MN | 0.48 (0.27 to 0.85) |
| Almind6 | 1989 | RCT* | 96* | PSP (71) SSP (25)* | Tetracycline via chest drain (33) | 13.0% (3.9% to 43.9%) | Drainage only (34) | 36.0% (15.9% to 81.5%) | 55MN | 0.27 (0.06 to 1.15) |
| Wied41 | 1983 | RCT | 41 | PSP (41) | Tetracycline at thoracoscopy (18) | 0% (0.0% to 16.7%) | Silver nitrate (22) | 0% (0.0% to 13.6%) | 14MD | – |
| Prospective series—medical | ||||||||||
| Alfageme42 | 1994 | Prospective case series | 146 | PSP (96) SSP (50) | Tetracycline via chest drain (78) | 18.9%† (10.6% to 33.8%) | Drainage only (68) | 35.3% (19.9% to 62.7%) | 45MN | 0.43 (0.19 to 0.97) |
| Prospective series—surgical | ||||||||||
| Waterworth47 | 1995 | Prospective series | 32 | PSP (32) | VATS+bullectomy+tetracycline (32) | 9.4% (2.9% to 30.8%) | – | – | 19MD | – |
| Retrospective case series—medical (with comparator group) | ||||||||||
| Guo43 | 2005 | Retrospective case series | 138 | PSP (86) SSP (52) | Tetracycline via chest drain (45) | 33.3% (17.9% to 62.0%) | Drainage only (70) | 50.0% (31.3% to 79.9%) | 6–69 | 0.50 (0.23 to 1.09) |
| Tanaka44 | 1993 | Retrospective case series | 78‡ | SSP (78) | Tetracycline via chest drain (32) | 18.8% (7.7% to 45.6%) | Drainage only (46) | 47.8% (26.8% to 85.3%) | 48MN | 0.25 (0.09 to 0.73) |
| van den Brande45 | 1989 | Retrospective case series | 20 | PSP (20) | Tetracycline and 30% glucose via chest drain (10) | 30.0% (7.8% to 100%) | Drainage only (10) | 50.0% (14.5% to 100%) | 26MN (intervention) and 18MN (control) | 0.43 (0.07 to 2.68) |
| Retrospective case series—surgical (with comparator group) | ||||||||||
| Lee46 | 2008 | Retrospective case series | 91 | PSP (91) | VATS+bullectomy+tetracycline (27) | 0.0% (0.0% to 11.1%) | Drainage only (64) | 10.9% (5.0% to 24.0%) | 16MN | 0.14 (0.01 to 2.53) |
| Retrospective case series—medical (no comparator group) | ||||||||||
| Olsen64 | 1992 | Retrospective case series | 390§ | PSP (390) | Tetracycline at thoracoscopy (390) | 15.6% (11.9% to 20.6%) | § | § | 43MD | – |
| Primrose65 | 1984 | Retrospective case series | 19¶ | Unclear | Tetracycline via chest drain (19) | 47.4% (19.2% to 100%) | – | – | Unclear | – |
Follow-up range shown if no average given.
*RCT had three arms (total numbers include talc arm, n=29).
†Includes eight early treatment failures.
‡Excluding patients being observed or aspirated only and those having thoracotomy.
§Thoracotomy and bullectomy were performed in those with bullae >2 cm at thoracoscopy—not included in analysis.
¶Small subgroup of patients undergoing pleurodesis.
MD, median; MN, mean; PSP, primary spontaneous pneumothorax; RCT, randomised controlled trial; SSP, secondary spontaneous pneumothorax; VATS, video-assisted thoracic surgery.