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November 7, 1990, Vol 264, No. 17 >
ARTICLE | November 7, 1990

Intrapleural Tetracycline for the Prevention of Recurrent Spontaneous Pneumothorax: Title and subTitle BreakResults of a Department of Veterans Affairs Cooperative Study FREE

Richard W. Light, MD; Vincent S. O'Hara, MD; Thomas E. Moritz, MS; A. James McElhinney, MD; Ralph Butz, MD; Clair M. Haakenson, RPh, MS; Raymond C. Read, MD; Catherine S. Sassoon, MD; Charles E. Eastridge, MD; Rolando Berger, MD; Larry J. Fontenelle, MD; Richard H. Bell, Jr, MD; Stephen G. Jenkinson, MD; Deborah Shure, MD; Walter Merrill, MD; Edward Hoover, MD; Sammy C. Campbell, MD
[+] Author Affiliations

A complete list of the members and their affiliations for the Department of Veterans Affairs Cooperative Study Group on Spontaneous Pneumothorax appears at the end of this article.

Reprint requests to Veterans Affairs Medical Center/151, 5901 E 7th St, Long Beach, CA 90822 (Dr Light).


JAMA. 1990;264(17):2224-2230. doi:10.1001/jama.1990.03450170072025
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References

This prospective, multicenter, randomized, "unblinded," controlled clinical trial was designed to determine if the intrapleural instillation of 1500 mg of tetracycline hydrochloride would be effective in diminishing the ipsilateral rate of recurrence for spontaneous pneumothorax. During the 4-year enrollment period, 113 patients were assigned to the tetracycline group; 116 patients were assigned to the control group. During the 5-year study period, the recurrence rate in the tetracycline group (25%) was significantly less than that in the control group (41%). Use of tetracycline seemed to reduce the recurrence rates for patients with either primary or secondary spontaneous pneumothorax and for patients with either an initial or a recurrent pneumothorax. We conclude that the intrapleural administration of tetracycline in patients with spontaneous pneumothorax significantly reduces the rate of ipsilateral recurrence but is associated with intense chest pain. Intrapleural tetracycline therapy is indicated for patients with a spontaneous pneumothorax who are hospitalized and are treated with tube thoracostomy.

(JAMA. 1990;264:2224-2230)

REFERENCES

1 +
Melton LJ, Hepper NGG, Offord KP.  Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974 . Am Rev Respir Dis. 1979;;120:1379-1382.
2 +
Seremetis MG.  The management of spontaneous pneumothorax . Chest. 1970;;57:65-68.
3 +
Larrieu AJ, Tyers GFO, Williams EH, O'Neill MJ, Derrick JR.  Intrapleural instillation of quinacrine for treatment of recurrent spontaneous pneumothorax . Ann Thorac Surg. 1979;;28:146-150.
4 +
Gobbel WG Jr, Rhea WG Jr, Nelson IA, Daniel RA Jr.  Spontaneous pneumothorax . J Thorac Cardiovasc Surg. 1963;;46:331-345.
5 +
Voge VM, Anthracite R.  Spontaneous pneumothorax in the USAF aircrew population: a retrospective study . Aviat Space Environ Med. 1986;;57:939-949.
6 +
Videm V, Pillgram-Larsen J, Ellingsen O, Andersen G, Ovrum E.  Spontaneous pneumothorax in chronic obstructive pulmonary disease: complications, treatment and recurrences . Eur J Respir Dis. 1987;;71:365-371.
7 +
Weeden D, Smith GH.  Surgical experience in the management of spontaneous pneumothorax, 1972-1982 . Thorax. 1983;;38:737-743.
8 +
Adler RH.  A talc powder aerosol method for the prevention of recurrent spontaneous pneumothorax . Ann Thorac Surg. 1968;;5:474-477.
9 +
Tribble CG, Selden RF, Rodgers BM.  Talc poudrage in the treatment of spontaneous pneumothoraces in patients with cystic fibrosis . Ann Surg. 1986;;204:677-680.
10 +
Almind M, Lange P, Viskum K.  Spontaneous pneumothorax: comparison of simple drainage, talc pleurodesis, and tetracycline pleurodesis . Thorax. 1989;;44:627-630.
11 +
Cattaneo SM, Sirak HD, Klassen KP.  Recurrent spontaneous pneumothorax in the high-risk patients: management with intrapleural quinacrine . J Thorac Cardiovasc Surg. 1973;;66:467-471.
12 +
Stowe SM, Boat TF, Mendelsohn H, et al.  Open thoracotomy for pneumothorax in cystic fibrosis . Am Rev Respir Dis. 1975;;111:611-617.
13 +
Ofoegbu RO.  Pleurodesis for spontaneous pneumothorax: experience with intrapleural olive oil in high risk patients . Am J Surg. 1980;;140:679-681.
14 +
Olivier AF.  Tetracycline pleurodesis for refractory pneumothorax among inoperable elderly surgical candidates . Chest. 1982;;82:512.
15 +
Wang YT, Ng KY, Poh SC.  Intrapleural tetracycline for spontaneous pneumothorax with persistent air leak . Singapore Med J. 1988;;29:72-73.
16 +
Stephenson LW.  Treatment of pneumothorax with intrapleural tetracycline . Chest. 1985;;88:803-804.
17 +
Tassi GF, Di Fabio D, Chiodera PL, Foccoli P, Zogno M.  Intrapleural tetracycline for recurrent pneumothorax . Chest. 1983;;83:535.
18 +
Sahn SA, Good JT.  The effect of common sclerosing agents on the rabbit pleural space . Am Rev Respir Dis. 1981;;124:65-67.
19 +
Gardner RN.  ATS statement Snowbird workshop on standardization for spirometry . Am Rev Respir Dis. 1979;;119:831.
20 +
Wied U, Halkier E, Hoeier-Madsen K, Plucnar B, Rasmussen E, Sparup J.  Tetracycline versus silver nitrate pleurodesis in spontaneous pneumothorax . J Thorac Cardiovasc Surg. 1983;;86:591-593.
21 +
Krasnik M, Christensen B, Halkier E, Hoier-Madsen K, Jeines R, Wied U.  Pleurodesis in spontaneous pneumothorax by means of tetracycline: follow-up evaluation of a method . Scand J Thorac Cardiovasc Surg. 1987;;21:181-182.
22 +
Primrose WR.  Spontaneous pneumothorax: a retrospective review of aetiology, pathogenesis and management . Scott Med J 1984;;29:15-20.
23 +
Fox RE Jr.  Refractory and recurrent spontaneous pneumothorax: a medical or surgical disease? medical management with intrapleural tetracycline . J Am Osteopath Assoc. 1979;;78:882-888.
24 +
Goldszer RC, Bennett J, VanCampen J, Rudnitzky J.  Intrapleural tetracycline for spontaneous pneumothorax . JAMA. 1979;;241:724-725.
25 +
Rinaldo JE, Owens GR, Rogers RM.  Adult respiratory distress syndrome following intrapleural instillation of talc . J Thorac Cardiovasc Surg. 1983;;85:523-526.
26 +
Wooten SA, Barbarash RA, Strange C, Sahn SA.  Systemic absorption of tetracycline and lidocaine following intrapleural instillation . Chest. 1988;;94:960-963.
27 +
Sherman S, Ravikrishnan KP, Patel AS, Seidman JC.  Optimum anesthesia with intrapleural lidocaine during chemical pleurodesis with tetracycline . Chest. 1988;;93:533-536.
28 +
Viskum K, Lange P, Mortensen J.  Long term sequelae after talc pleurodesis for spontaneous pneumothorax . Pneumologie. 1989;;43:105-106.
29 +
Macoviak JA, Stephenson LW, Ochs R, Edmunds LH Jr.  Tetracycline pleurodesis during active pulmonary-pleural air leak for prevention of recurrent pneumothorax . Chest. 1982;;81:78-81.
30 +
Schields TW, Oilschlager GA.  Spontaneous pneumothorax in patients 40 years of age and older . Ann Thorac Surg. 1966;;2:377-383.
31 +
Dines DE, Clagett OT, Payne WS.  Spontaneous pneumothorax in emphysema . Mayo Clin Proc. 1970;;45:481-487.
32 +
George RB, Herbert SJ, Shames JM, Ellithorpe DB, Weill H, Ziskind MM.  Pneumothorax complicating pulmonary emphysema . JAMA. 1975;;234: 389-393.

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1 +
Melton LJ, Hepper NGG, Offord KP.  Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974 . Am Rev Respir Dis. 1979;;120:1379-1382.
2 +
Seremetis MG.  The management of spontaneous pneumothorax . Chest. 1970;;57:65-68.
3 +
Larrieu AJ, Tyers GFO, Williams EH, O'Neill MJ, Derrick JR.  Intrapleural instillation of quinacrine for treatment of recurrent spontaneous pneumothorax . Ann Thorac Surg. 1979;;28:146-150.
4 +
Gobbel WG Jr, Rhea WG Jr, Nelson IA, Daniel RA Jr.  Spontaneous pneumothorax . J Thorac Cardiovasc Surg. 1963;;46:331-345.
5 +
Voge VM, Anthracite R.  Spontaneous pneumothorax in the USAF aircrew population: a retrospective study . Aviat Space Environ Med. 1986;;57:939-949.
6 +
Videm V, Pillgram-Larsen J, Ellingsen O, Andersen G, Ovrum E.  Spontaneous pneumothorax in chronic obstructive pulmonary disease: complications, treatment and recurrences . Eur J Respir Dis. 1987;;71:365-371.
7 +
Weeden D, Smith GH.  Surgical experience in the management of spontaneous pneumothorax, 1972-1982 . Thorax. 1983;;38:737-743.
8 +
Adler RH.  A talc powder aerosol method for the prevention of recurrent spontaneous pneumothorax . Ann Thorac Surg. 1968;;5:474-477.
9 +
Tribble CG, Selden RF, Rodgers BM.  Talc poudrage in the treatment of spontaneous pneumothoraces in patients with cystic fibrosis . Ann Surg. 1986;;204:677-680.
10 +
Almind M, Lange P, Viskum K.  Spontaneous pneumothorax: comparison of simple drainage, talc pleurodesis, and tetracycline pleurodesis . Thorax. 1989;;44:627-630.
11 +
Cattaneo SM, Sirak HD, Klassen KP.  Recurrent spontaneous pneumothorax in the high-risk patients: management with intrapleural quinacrine . J Thorac Cardiovasc Surg. 1973;;66:467-471.
12 +
Stowe SM, Boat TF, Mendelsohn H, et al.  Open thoracotomy for pneumothorax in cystic fibrosis . Am Rev Respir Dis. 1975;;111:611-617.
13 +
Ofoegbu RO.  Pleurodesis for spontaneous pneumothorax: experience with intrapleural olive oil in high risk patients . Am J Surg. 1980;;140:679-681.
14 +
Olivier AF.  Tetracycline pleurodesis for refractory pneumothorax among inoperable elderly surgical candidates . Chest. 1982;;82:512.
15 +
Wang YT, Ng KY, Poh SC.  Intrapleural tetracycline for spontaneous pneumothorax with persistent air leak . Singapore Med J. 1988;;29:72-73.
16 +
Stephenson LW.  Treatment of pneumothorax with intrapleural tetracycline . Chest. 1985;;88:803-804.
17 +
Tassi GF, Di Fabio D, Chiodera PL, Foccoli P, Zogno M.  Intrapleural tetracycline for recurrent pneumothorax . Chest. 1983;;83:535.
18 +
Sahn SA, Good JT.  The effect of common sclerosing agents on the rabbit pleural space . Am Rev Respir Dis. 1981;;124:65-67.
19 +
Gardner RN.  ATS statement Snowbird workshop on standardization for spirometry . Am Rev Respir Dis. 1979;;119:831.
20 +
Wied U, Halkier E, Hoeier-Madsen K, Plucnar B, Rasmussen E, Sparup J.  Tetracycline versus silver nitrate pleurodesis in spontaneous pneumothorax . J Thorac Cardiovasc Surg. 1983;;86:591-593.
21 +
Krasnik M, Christensen B, Halkier E, Hoier-Madsen K, Jeines R, Wied U.  Pleurodesis in spontaneous pneumothorax by means of tetracycline: follow-up evaluation of a method . Scand J Thorac Cardiovasc Surg. 1987;;21:181-182.
22 +
Primrose WR.  Spontaneous pneumothorax: a retrospective review of aetiology, pathogenesis and management . Scott Med J 1984;;29:15-20.
23 +
Fox RE Jr.  Refractory and recurrent spontaneous pneumothorax: a medical or surgical disease? medical management with intrapleural tetracycline . J Am Osteopath Assoc. 1979;;78:882-888.
24 +
Goldszer RC, Bennett J, VanCampen J, Rudnitzky J.  Intrapleural tetracycline for spontaneous pneumothorax . JAMA. 1979;;241:724-725.
25 +
Rinaldo JE, Owens GR, Rogers RM.  Adult respiratory distress syndrome following intrapleural instillation of talc . J Thorac Cardiovasc Surg. 1983;;85:523-526.
26 +
Wooten SA, Barbarash RA, Strange C, Sahn SA.  Systemic absorption of tetracycline and lidocaine following intrapleural instillation . Chest. 1988;;94:960-963.
27 +
Sherman S, Ravikrishnan KP, Patel AS, Seidman JC.  Optimum anesthesia with intrapleural lidocaine during chemical pleurodesis with tetracycline . Chest. 1988;;93:533-536.
28 +
Viskum K, Lange P, Mortensen J.  Long term sequelae after talc pleurodesis for spontaneous pneumothorax . Pneumologie. 1989;;43:105-106.
29 +
Macoviak JA, Stephenson LW, Ochs R, Edmunds LH Jr.  Tetracycline pleurodesis during active pulmonary-pleural air leak for prevention of recurrent pneumothorax . Chest. 1982;;81:78-81.
30 +
Schields TW, Oilschlager GA.  Spontaneous pneumothorax in patients 40 years of age and older . Ann Thorac Surg. 1966;;2:377-383.
31 +
Dines DE, Clagett OT, Payne WS.  Spontaneous pneumothorax in emphysema . Mayo Clin Proc. 1970;;45:481-487.
32 +
George RB, Herbert SJ, Shames JM, Ellithorpe DB, Weill H, Ziskind MM.  Pneumothorax complicating pulmonary emphysema . JAMA. 1975;;234: 389-393.

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