Low-dose talc plus low-dose doxycycline for pleuroscopic pleurodesis: Initial experience

OBJECTIVE: We performed a retrospective review of the use of the combination of talc and doxycycline for pleurodesis in patients. METHODS: There were 33 sequential cases over a 2-year period. Doses of doxycycline (250 mg) and talc (2.5 g) were half the "usual" doses. RESULTS: Thirty-three cases were identified (20 women, 13 men, average age 64 y). No immediate perioperative complications were noted. Chest tube duration averaged 4.2±2.6 days. Total drainage averaged 880 mL. Length of stay after procedure in the outpatient group was 4.8±3.1 days. Eleven patients (33%) reported persistence or worsening dyspnea in the immediate postoperative period. Only 2 developed respiratory distress; neither had any parenchymal changes on chest radiology or required ventilatory support. Other immediate postoperative events included chest pain in 18 patients (54%) and fever in 3. Follow-up imaging was available for 29 patients, an average of 3.9 months postoperatively. Twenty patients (69%) had complete pleurodesis, 4 patients (14%) had partial pleurodesis, and 5 (17%) failed. In no case did follow-up imaging demonstrate new adult respiratory distress-like infiltrates. CONCLUSIONS: The combination of low-dose doxycycline with low-dose talc appears to be a safe and rational approach to pleuroscopic pleurodesis in patients. The success rate matched that of the literature for talc alone. The side-effect profile was reasonable. No severe sequelae were observed. A prospective clinical trial seems warranted.