Experimental Pleurodesis Induced by Antibiotics (Macrolides or Quinolones)

Abstract

Teixeira LR, Vargas FS, Acencio MMP, Bumlai RUM, Antonangelo L, Marchi E. Experimental pleurodesis induced by antibiotics (macrolides or quinolones). Clinics. 2006;61(6):559-64. PURPOSE:Chemical pleurodesis is a therapeutic tool for the treatment of recurrent pleural effusions, mainly those of neoplastic etiology. In the past, tetracycline was the sclerosant agent of choice in clinical practice, but presently, there is no consensus about an ideal agent. The aim of this study was to evaluate the effectiveness of macrolides (azithromycin and clarithromycin) or quinolones (levofloxacin and gatifloxacin) in inducing experimental pleurodesis in rabbits. METHOD: Forty New Zealand rabbits randomized into groups of 10 received (at a total volume of 2 mL for each animal) 1 of the 4 drugs by intrapleural injection. After 28 days, the animals were euthanized and the pleural cavity was evaluated macroscopically and microscopically. RESULTS: The intensity of the macroscopic adhesions was mild in all groups. On microscopic analysis, minimal pleural fibrosis and inflammation were observed in all animals. CONCLUSION: The macrolides (azithromycin or clarithromycin) and the quinolones (levofloxacin or gatifloxacin) when injected into the normal pleural space of rabbits are not effective in promoting pleurodesis. Additional research is required to identify sclerosing agents capable of inducing pleurodesis.

Inflammation and Clinical Repercussions of Pleurodesis Induced by Intrapleural Talc Administration

“…4 Some antibiotics have demonstrated a sclerosing effect (tetracycline), 5 whereas no marked efficacy has been observed for others (macrolides and quinolones). 6 Similarly, antineoplastic agents (bleomycin), 7 immunostimulants (Corynebacterium parvum and OK-432), 8,9 chemical irritants (talc and silver nitrate), 10,11 and more recently, biological mediators of inflammation (transforming growth factor-beta (TGF-β) and interferon) 12,13 have been effective in the production of pleurodesis. The use of povidone-iodine, 14 autologous blood, 15 and polidocanol 16 has also been reported in some studies.…”

Blockage of vascular endothelial growth factor (VEGF) reduces experimental pleurodesis

“…After 7, 14, or 28 days, 5 animals from each group were euthanized by intravenous injection (marginal ear vein) of 40 mg/kg of pentobarbital [12,13]. The thorax was removed en bloc, and by using 10% formalin, the lungs were expanded (60 mL) and maintained submersed for at least 48 h [12,13].…”

“…The thorax was removed en bloc, and by using 10% formalin, the lungs were expanded (60 mL) and maintained submersed for at least 48 h [12,13].…”

“…Samples of visceral pleura were obtained from all pulmonary lobes. When adhesions or symphysis were present careful dissection was done in order to adequately collect representative fragments [12,13]. A consensus grading of the macroscopic pleurodesis was reached by two independent investigators (LRT and MMPA) who were blinded concerning the treatment group.…”

“…A consensus grading of the macroscopic pleurodesis was reached by two independent investigators (LRT and MMPA) who were blinded concerning the treatment group. For assessment of the pleural adhesions, a 0-4 score was used (0: normal pleural space; 1: up to 3 discrete adhesions; 2: more than 3 sparse adhesions; 3: generalized adhesions allowing separation of the lung from the thoracic wall, and 4: complete obliteration of the pleural space) [12,13].…”