Tuberculous pericarditis medical therapy
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Tuberculous pericarditis Microchapters |
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Differentiating Tuberculous pericarditis from other Diseases |
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Tuberculous pericarditis medical therapy On the Web |
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Risk calculators and risk factors for Tuberculous pericarditis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Ahmed Zaghw, M.D. [2]
Anti-Tuberculosis Chemotherapy
With the use of antituberculosis chemotherapy, survival rate in tuberculous pericarditis has improved dramatically. Mortality rate in preantibiotic era was 80-90%[1]. At present it is 8-17%[2][3] and 17-34% if associated with HIV[4]. A 2months course of isoniazid, pyrazinamide, rifampicin, and ethambutol followed by 4months course of isoniazid and rifampicin is shown to be effective[5]. Short course chemotherapy is beneficial in HIV infected patients[6].
Empirical Anti-Tuberculosis Therapy
It should be considered that in developing countries where TB is endemic and in cases with high clinical suspicion of tuberculous pericarditis, starting with empiric antituberculous therapy is appropriate before establishing a definitive diagnosis. In the clinical settings where the diagnosis cannot be established based on bacteriology, histology, or pericardial fluid analysis, clinical response to antituberculous therapy serves as support for a diagnosis of tuberculous pericarditis.[7] In developed countries where TB is not endemic, antituberculous therapy should generally not be initiated empirically in the absence of definitive diagnosis.[8]
Role of Corticosteroids in Tuberculous pericarditis
The American Thoracic Society, CDC, and Infectious Diseases Society of America recommends in 2003 the use of corticosteroids (prednisone) as adjunctive therapy for tuberculous pericarditis during the first 11 weeks of antituberculosis therapy[9]. However the Infectious Diseases Society of America recommends a shorter course of 60 mg of prednisone daily, get tapered by 10/mg day each week over a six-week period in HIV. In contrary to the standard full 11 week course, the 6 week course has demonstrated efficacy in HIV-seropositive patients with tuberculous pericarditis.[10]
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† or the equivalent dose of prednisolone
References
- ↑ Harvey AM, Whitehill MR. Tuberculous pericarditis. Medicine. 1937; 16: 45–94
- ↑ Desai HN (1979). "Tuberculous pericarditis. A review of 100 cases". S Afr Med J. 55 (22): 877–80. PMID 472922.
- ↑ Bhan GL (1980). "Tuberculous pericarditis". J Infect. 2 (4): 360–4. PMID 7185934.
- ↑ Hakim JG, Ternouth I, Mushangi E, Siziya S, Robertson V, Malin A (2000). "Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients". Heart. 84 (2): 183–8. PMC 1760932. PMID 10908256.
- ↑ Cohn DL, Catlin BJ, Peterson KL, Judson FN, Sbarbaro JA (1990). "A 62-dose, 6-month therapy for pulmonary and extrapulmonary tuberculosis. A twice-weekly, directly observed, and cost-effective regimen". Ann Intern Med. 112 (6): 407–15. PMID 2106816.
- ↑ Perriëns JH, St Louis ME, Mukadi YB, Brown C, Prignot J, Pouthier F; et al. (1995). "Pulmonary tuberculosis in HIV-infected patients in Zaire. A controlled trial of treatment for either 6 or 12 months". N Engl J Med. 332 (12): 779–84. doi:10.1056/NEJM199503233321204. PMID 7862181.
- ↑ Mayosi, BM.; Burgess, LJ.; Doubell, AF. (2005). "Tuberculous pericarditis". Circulation. 112 (23): 3608–16. doi:10.1161/CIRCULATIONAHA.105.543066. PMID 16330703. Unknown parameter
|month=ignored (help) - ↑ Soler-Soler, J.; Sagristà-Sauleda, J.; Permanyer-Miralda, G. (2001). "Management of pericardial effusion". Heart. 86 (2): 235–40. PMID 11454853. Unknown parameter
|month=ignored (help) - ↑ American Thoracic Society. CDC. Infectious Diseases Society of America (2003). "Treatment of tuberculosis". MMWR Recomm Rep. 52 (RR-11): 1–77. PMID 12836625.
- ↑ "http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf" (PDF). Retrieved 20 January 2014. External link in
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