Dosage and effectiveness of intrapleural doxycycline for pediatric postcardiotomy pleural effusions.
OBJECTIVE
To determine the effectiveness of intrapleural doxycycline for the treatment of postcardiotomy pleural effusions in pediatric patients.


METHODS
Retrospective case series.


METHODS
Intensive care unit in a pediatric tertiary care center.


METHODS
Sequential sample of 12 pediatric patients who underwent cardiotomy for congenital heart disease and received doxycycline pleurodesis for persistent pleural effusion that lasted more than 7 days between December 21, 2001, and May 23, 2005.


RESULTS
Mean age of the patients was 1 year (range 2 wks-2.5 yrs). Eighteen courses of doxycycline were administered among the 12 patients. An average dose of 19.1 mg/kg/dose of parenteral doxycycline was diluted in normal saline to a final syringe concentration of 2-8 mg/ml and injected through a chest tube. The patient was rotated according to a protocol. The doxycycline dose remained in the pleural space for approximately 6 hours before being drained under suction. Treatment success was defined as achievement of 0-ml/hour chest tube output after a doxycycline dose. The overall treatment success rate was 94% (17 of 18 courses). The mean times from dosing to treatment success and chest tube removal were 76 hours (range < 1 to 140 hrs) and 130 hours (range 8-453 hrs), respectively. Seventy-two percent of the courses (13 of 18) achieved treatment success within 96 hours and chest tube removal within 168 hours after dosing. Doxycycline concentration did not appear to be related to treatment success. Chest pain was the most common adverse effect.


CONCLUSIONS
Intrapleural doxycycline infusion is effective for postcardiotomy pleural effusion in pediatric patients with persistent chest tube drainage lasting more than 7 days.
Hoff
David S
DS
Department of Pharmacy, Children's Heart Clinic at Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55404, USA. david.hoff@childrensmn.org
Gremmels
David B
DB
Hall
Karen M
KM
Overman
David M
DM
Moga
Francis X
FX
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D015505:Chest Tubes; D002675:Child, Preschool; D004318:Doxycycline / Q000627:therapeutic use*; D004322:Drainage; D005260:Female; D006801:Humans; D007223:Infant; D007263:Infusions, Parenteral; D008297:Male; D010996:Pleural Effusion / Q000188:drug therapy*; D011183:Postoperative Complications
D000900:Anti-Bacterial Agents; D004318:Doxycycline