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Intrapleural Tetracycline for Recurrent Pneumothorax

John R. Corboy, MD
JAMA. 1991;265(9):1110. doi:10.1001/jama.1991.03460090058018.
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To the Editor.—  The recent study by Light et al1 on the use of intrapleural tetracycline to prevent recurrent spontaneous pneumothorax is an excellent example of a statistically significant improvement in outcome associated with an overall persistently poor outcome.Although it was true that 41% of untreated patients had recurrence, so did an astounding 25% of men treated with a drug that caused severe chest pain in over half. Even patients with primary pneumothorax (who presumably were younger and healthier) had a 10.5% recurrence rate with treatment. Thoracotomy with pleural abrasion is associated with a low risk of serious complications, with the risk greatest in elderly patients with chronic obstructive pulmonary disease, but typically carries a recurrence rate of less than 1%.2 Thus, a blanket recommendation to attempt intrapleural installation of tetracycline to prevent recurrent spontaneous pneumothorax is unjustified.Given that treatment with intrapleural tetracycline still results in


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