Pleurodesis by erythromycin, tetracycline, AerosilTM 200, and erythromycin plus AerosilTM 200 in a rat model: a preliminary study

Background: None of the current pleurodesing agents fulfil all the criteria for best pleural sclerosant. Therefore, the search for the ideal agent for chemical pleurodesis still continues. The aim of the present study was to compare the effectiveness of erythromycin, tetracycline, AerosilTM 200 (hydrophilic fumed amorphous silica), and erythromycin plus AerosilTM 200 in producing pleurodesis in rats. In the present study, talc was not used as a pleurodesing agent due to an unavailability of its sterile and pure form in Iran. Methods: Overall, 75 adult male Spraque-Dawley rats were randomized to 5 treatment groups. Each group received an intrapleural injection via 5 Fr Silastic tubes of one of the following sterile agents: 35mg/kg erythromycin in 2 ml of saline, 35mg/kg tetracycline in 2 ml of saline, 35mg/kg AerosilTM 200 in 2ml of saline, erythromycin (35mg/kg in 2 ml of saline) plus AerosilTM 200 (35mg/kg in 2 ml of saline), or 2 ml of saline as a control. The animals were euthanized and necropsied 30 days after injection. The pleurae were assessed for macroscopic and microscopic evidence of surrounding inflammation and fibrosis. Results: The median macroscopic score in the AerosilTM 200 group was significantly higher than that in the erythromycin group (P 0.005). The median microscopic score in the erythromycin group was significantly lower than that in the AerosilTM 200 and erythromycin plus AerosilTM 200 groups (P 0.005). Furthermore, maximum and minimum pleural fibrosis was observed in the erythromycin plus AerosilTM 200 and erythromycin groups, respectively (P 0.05). Conclusion: This study suggests that AerosilTM 200 with or without erythromycin may be more potent pleurodesis agent than erythromycin and tetracycline.