Doxycycline poudrage: An old agent for a new technique

Pleurodesis is an, if not the most, important palliative option for management of symptomatic malignant pleural effusion (MPE). Asbestos-free calibrated talc is the most effective agent known for pleurodesis. Unfortunately, this agent is not available in many countries including Egypt. Doxycycline is an old agent used for pleurodesis. No data exists about doxycycline poudrage via thoracoscopy for pleurodesis in malignant pleural effusion. To assess the efficacy, safety and outcome of medical thoracoscopic doxycycline poudrage in symptomatic MPE. This is a prospective cohort clinical study. Thirty patients with symptomatic MPE were enrolled in March 2013 through March 2014. Medical thoracoscopic pleurodesis was done using oral forms of doxycycline. Patients were followed up for 90 days after the procedure. Efficacy was judged both clinically and radiologically. Procedure-related complications were recorded. Patients were 20 males and 10 females. Mean age±SD was 57.67±13.29years. The most common primary neoplasms were lung cancer and breast cancer (both, n=11). After 90days, 19 out of 22 surviving patients (86.4%, 95%CI=59.8–94.8%) had successful pleurodesis. No procedure-related major complications were recorded. Minor adverse effects included pain (28.6%), fever (25%) and wound infection (10.7%). Survival rate at 90dayswas 78.6%. Mean duration of hospitalization was 1.93±0.92days. Doxycycline, as an old agent, when poudraged during medical thoracoscopy proved to be safe and effective agent for pleurodesis in symptomatic malignant pleural effusion.