Pleural effusion: pleurodesis: multiple instillations of tetracycline were probably no better than one.

Clinical bottom line (level 1b-)

Multiple instillations of tetracycline were not clearly better than a single instillation at preventing recurrence of malignant pleural effusions.

Landvater et al: Chest 1988; 93 (6): 1196-1198

Expires October 2003

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: university hospital, USA

50 patients (aged ?, ?% male) progressive dyspnoea or chest discomfort from malignant pleural effusions
Control Group: (n = 25, 25 analysed): single instillation of tetracycline
Experimental Group: (n = 25, 25 analysed): instillation of tetracycline on two consecutive days
All patients had a 28 or 32-French chest drain inserted into the affected hemithorax, which was allowed to drain for several hours before instillation of tetracycline for 30 minutes (20 mg/kg to a max of 2 g in 50 ml normal saline). Some patients also received 20 ml of 1% lidocaine. Patients changed position every ten minutes. Suction was then applied until drainage was < 150 ml/ day.
100% followed for ?
Outcome notes:

recurrence of effusion : causing dyspnoea or other respiratory compromise, requiring thoracentesis or resclerosis

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNT (95% CI)
recurrence of effusion	unknown	4 (16.0%)	4 (16.0%)	0% (-256% to 72%)	0.00% (-20.3% to 20.3%)	inf (NNT = 5 to infinity; NNH = 5 to infinity)

Comments

The study is not large enough to show any benefit from multiple instillations of tetracycline.

Citation

Landvater L, Hix WR, Mills M, et al: malignant pleural effusion treated by tetracycline sclerotherapy: a comparison of single vs repeated instillation. Chest 1988; 93 (6): 1196-1198

Search Terms: pleural effusion in Cochrane
Contributor: Chris Ball and Clare Wotton, October 2000
Reviewer:

_{Clinical Question.}

_Patient	_{pleural effusion}
_{Intervention or Exposure}	_{single instillation of tetracycline}
_Comparison	_{multiple instillations of tetracycline}
_Outcome	_recurrence