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EXPERIMENTAL PLEURODESIS: INTRAPLEURAL INJECTION OF AZYTHROMYCIN, CLARITHROMYCIN OR LEVOFLOXACIN

Pulmonary Division, Heart Institute (InCor), Sao Paulo Medical School, Sao Paulo, Brazil

PURPOSE: Pleurodesis is commonly used to treat recurrent pleural effusion or pneumothorax. The ideal agent for pleurodesis is still being sought. Previous studies demonstrated that intrapleural instillation of erythromycin, a macrolide antibiotic, could be a potential pleural sclerosing agent. There is no studies demonstrating the effect of quinolones as pleural sclerosing. The aim of this study was to evaluate the intrapleural injection of azythromycin, clarithromycin or levofloxacin as pleural sclerosing agents.

METHODS: Thirty rabbits, divided in 3 groups received, through a chest tube, intrapleural administration of azythromycin (15mg/kg), clarithromycin (15 mg/kg) or levofloxacin (10 mg/kg) in a total volume of 2ml. After 28 days the animals were sacrificed and the degree of pleural adhesions were evaluated in a score from 0 (no adhesions ) to 4 (complete obliteration of pleural space). Pleurodesis are considered when score >3. We also evaluated the microscopic changes for inflammation and fibrosis in scores from 0 to 4 according to the intensity of process. Statistical analysis: Descriptive Analysis (mean + standard deviation) and Kruskall Wallis ANOVA .

RESULTS: After the intrapleural administration of azythromycin, clarithromycin or levofloxacin we observed a few macroscopic adhesions. The scores were 1.2 ± 0.5, 1.2 ± 1.0 and 1.0 ± 0.5 respectively, and no statistical difference were observed among the groups. The microscopic analysis of pleura and parenchyma showed discrete changes for all drugs, with a greater scores of pleural fibrosis in the clarithromycin group.

CONCLUSION: The intrapleural injection of azythromycin, clarithromycin or levofloxacin was ineffective in creating pleurodesis in our experimental model.

CLINICAL IMPLICATIONS: Macrolides or quinolones should not be recommended as a pleural sclerosing agent, when a pleurodesis is attempt.

DISCLOSURE: Lisete Teixeira, None.