Efficacy and safety of erythromycin as sclerosing agent in patients with recurrent malignant pleural effusion

Am J Clin Oncol. 2008 Aug;31(4):384-9. doi: 10.1097/COC.0b013e318165c061.


Objectives: The aim of pleurodesis in malignant pleural effusions is to prevent reaccumulation of the fluid, symptoms, and avoid the need for repeated hospitalization for thoracentesis. The purpose of this study was to evaluate the efficacy and safety of erythromycin as a pleural sclerosing agent.

Methods: Over a 2-year period, 34 patients with a symptomatic, recurrent, malignant pleural effusion who referred for chest tube drainage and pleurodesis were included. They had not received prior intrapleural therapy and had predicted survival of at least 1 month. All underwent pleural drainage and chemical pleurodesis with erythromycin. Complications and response to pleurodesis, according to clinical and radiographic criteria after 90 days, were recorded.

Results: The overall response was 88.2%. Complete response (no reaccumulation of pleural fluid after 90 days) was observed in 27 patients (79.4%). Partial response (reaccumulation of fluid but without symptoms, not requiring drainage) was observed in 3 (8.8%). No response (symptomatic reaccumulation of fluid that required drainage) was observed in 4 (11.8%). All patients experienced pleurodynia that was treated with administration of paracetamol and/or dextropropoxyphene. Sinus tachycardia and concurrent mild systemic hypertension were observed 2 and 4 hours after pleurodesis. Both of them were attributed to pleurodynia as there was remission with analgesics.

Conclusions: This study suggests that erythromycin is effective and safe as a sclerosing agent for pleurodesis in patients with recurrent malignant pleural effusions.

MeSH terms

  • Adenocarcinoma / complications*
  • Adenocarcinoma / pathology
  • Adenocarcinoma / therapy
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Breast Neoplasms / complications
  • Breast Neoplasms / pathology
  • Breast Neoplasms / therapy
  • Carcinoma, Small Cell / complications
  • Carcinoma, Small Cell / pathology
  • Carcinoma, Small Cell / therapy
  • Carcinoma, Squamous Cell / complications
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy
  • Drainage
  • Erythromycin / therapeutic use*
  • Female
  • Humans
  • Kidney Neoplasms / complications
  • Kidney Neoplasms / pathology
  • Kidney Neoplasms / therapy
  • Male
  • Pleural Effusion, Malignant / etiology*
  • Pleural Effusion, Malignant / pathology
  • Pleural Effusion, Malignant / therapy*
  • Pleurodesis
  • Recurrence
  • Safety
  • Sclerosing Solutions / therapeutic use*
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Sclerosing Solutions
  • Erythromycin