Therapy

Use any of the following when performing medical pleurodesis:

• tetracycline ^b and bleomycin ^a
• doxycycline ^b
• minocycline ^b
• mepacrine  ^a

Why?

• Mepacrine prevents recurrent effusions more effectively than bleomycin ^a
• A combination of tetracycline and bleomycin is better than either alone at preventing recurrence.  There is no clear difference in the side effects between combination or single therapy ^a

Mepacrine prevents recurrent effusion better than bleomycin

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
malignant pleural effusion a	mepacrine pleurodesis	bleomycin pleurodesis	repeated thoracentesis required at 1 month	55%	73% (17% to 91%)	3 (1 to 8)
malignant pleural effusion a	tetracycline pleurodesis	tetracycline pleurodesis	recurrent effusion at 6 months	50%	60% (-7% to 85%)	3 (2 to 52)