Minocycline pleurodesis reduces recurrences after a first spontaneous pneumothoraxBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1125 (Published 21 February 2013) Cite this as: BMJ 2013;346:f1125
Spontaneous pneumothoraxes often recur after initial aspiration and drainage, and a recent trial from Taiwan suggests that early pleurodesis with minocycline can help reduce the risk. Participants, who were mostly young men, had simple aspiration and drainage with a small bore catheter. Those treated with minocycline pleurodesis via the same catheter had significantly fewer recurrences during the next year than controls given no further treatment (29.2% (31/106) v 49.1% (53/108); P=0.003).
The procedure was painful. Two thirds of those treated with pleurodesis need pethidine, compared with a fifth of controls. They also needed higher doses.
Chemical pleurodesis after a first spontaneous pneumothorax is an unorthodox approach, says a linked comment (doi:10.1016/S0140-6736(13)60285-8). One short term trial probably isn’t enough to change international guidelines, which currently recommend the more definitive surgical option after at least one recurrence.
Recurrence rates were high in both groups, and we don’t yet know whether early chemical pleurodesis complicates later thoracic surgery in those who will still need it, says the comment. Preliminary signs were good in this trial, but healthcare professionals will need further confirmation. They might also welcome trials of strategies that start with computed tomography of the chest. High resolution scans often identify bullae and other features associated with recurrences and may help identify patients most likely to benefit from early pleurodesis.
Cite this as: BMJ 2013;346:f1125