Intrapleural minocycline following simple aspiration for initial treatment of primary spontaneous pneumothorax.

Background: The optimal initial management of primary spontaneous pneumothorax (PSP) remains controversial. This study was to evaluate the safety and efficacy of intrapleural minocycline following aspiration for initial treatment of PSP.

Methods: Between January 2004 and November 2006, 64 patients with a first episode of PSP were successfully treated by simple aspiration using pigtail or intravenous needle catheter. From December 2005, 31 of the patients also received 300mg of minocycline hydrochloride post lung expansion, instilled through the catheter into the pleural space (minocycline group). The control group consisted of the first 33 patients of the series who had successfully undergone simple aspiration alone between January 2004 and December 2005.

Results: There was no significant difference between the two groups in terms of demographic data. Patients in the minocycline group had higher doses of meperidine injection. The group hospitalization rates and mean hospital stays were comparable. After a mean follow-up of 13 months (range 3-26), recurrence was noted in 4 of the minocycline group and 11 of the control group (12.9% versus 33.3%, p=0.045). Subsequent thoracoscopic surgery for the recurrent patients revealed that minocycline induced scant loose adhesions which did not significantly affect operation procedures. The long-term pulmonary function and rates of residual pain for the two groups were comparable.

Conclusions: Although associated with immediate chest pain, intrapleural minocycline following simple aspiration is a simple, safe and convenient initial treatment for PSP that may reduce the rates of ipsilateral recurrence.