Tetracycline for prevention of recurrent pneumothorax - Tips From Other Journals

Date: March, 1991

Spontaneous pneumothorax can be classified as either primary spontaneous pneumothorax, occurring in patients without antecedent lung disease; or secondary spontaneous pneumothorax, occurring in patients with underlying lung disease, most commonly chronic obstructive pulmonary disease. Spontaneous pneumothorax recurs in 23 to 52 percent of patients who have been treated with tube thoracostomy. Light and colleagues conducted a study to determine whether intrapleural instillation of tetracycline reduces the rate of recurrence in patients with spontaneous pneumotorax.

The study included 229 men with spontaneous pneumothorax who required tube thoracostomy. Patients were randomly assigned to a treatment group receiving 1,500 mg of tetracycline instilled into the pleural space (113 patients) or to a control group (116 patients). Patients were followed for at least one year.

During the five-year study period, the recurrence rate was 25.0 percent in the group treated with tetracycline, compared with a rate of 40.7 percent in the control group. Tetracycline seemed to be effective in preventing recurrence in patients with primary or secondary pneumothorax. The major complication was intense chest pain accompanying instillation of tetracycline.

The study findings demonstrate that intrapleural administration of tetracycline significantly decreases the recurrence rate of pneumothorax. The authors recommend this treatment for all patients with spontaneous pneumothorax who require tube thoracostomy. (JAMA, November 7, 1990, vol. 264, p. 2224.)

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