Tuberculous pericarditis medical therapy: Difference between revisions
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With the use of antituberculosis chemotherapy, survival rate in tuberculous pericarditis has improved dramatically. Mortality rate in preantibiotic era was 80-90%<ref>Harvey AM, Whitehill MR. Tuberculous pericarditis. Medicine. 1937; 16: 45–94</ref>. At present it is 8-17%<ref name="pmid472922">{{cite journal| author=Desai HN| title=Tuberculous pericarditis. A review of 100 cases. | journal=S Afr Med J | year= 1979 | volume= 55 | issue= 22 | pages= 877-80 | pmid=472922 | doi= | pmc= | url= }} </ref><ref name="pmid7185934">{{cite journal| author=Bhan GL| title=Tuberculous pericarditis. | journal=J Infect | year= 1980 | volume= 2 | issue= 4 | pages= 360-4 | pmid=7185934 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7185934 }} </ref> and 17-34% if associated with [[HIV]]<ref name="pmid10908256">{{cite journal| author=Hakim JG, Ternouth I, Mushangi E, Siziya S, Robertson V, Malin A| title=Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients. | journal=Heart | year= 2000 | volume= 84 | issue= 2 | pages= 183-8 | pmid=10908256 | doi= | pmc=PMC1760932 | url= }} </ref>. A 2months course of [[isoniazid]], [[pyrazinamide]], [[rifampicin]], and [[ethambutol]] followed by 4months course of [[isoniazid]] and [[rifampicin]] is shown to be effective<ref name="pmid2106816">{{cite journal| author=Cohn DL, Catlin BJ, Peterson KL, Judson FN, Sbarbaro JA| title=A 62-dose, 6-month therapy for pulmonary and extrapulmonary tuberculosis. A twice-weekly, directly observed, and cost-effective regimen. | journal=Ann Intern Med | year= 1990 | volume= 112 | issue= 6 | pages= 407-15 | pmid=2106816 | doi= | pmc= | url= }} </ref>. Short course chemotherapy is beneficial in [[HIV]] infected patients<ref name="pmid7862181">{{cite journal| author=Perriëns JH, St Louis ME, Mukadi YB, Brown C, Prignot J, Pouthier F et al.| title=Pulmonary tuberculosis in HIV-infected patients in Zaire. A controlled trial of treatment for either 6 or 12 months. | journal=N Engl J Med | year= 1995 | volume= 332 | issue= 12 | pages= 779-84 | pmid=7862181 | doi=10.1056/NEJM199503233321204 | pmc= | url= }} </ref>. | With the use of antituberculosis chemotherapy, survival rate in tuberculous pericarditis has improved dramatically. Mortality rate in preantibiotic era was 80-90%<ref>Harvey AM, Whitehill MR. Tuberculous pericarditis. Medicine. 1937; 16: 45–94</ref>. At present it is 8-17%<ref name="pmid472922">{{cite journal| author=Desai HN| title=Tuberculous pericarditis. A review of 100 cases. | journal=S Afr Med J | year= 1979 | volume= 55 | issue= 22 | pages= 877-80 | pmid=472922 | doi= | pmc= | url= }} </ref><ref name="pmid7185934">{{cite journal| author=Bhan GL| title=Tuberculous pericarditis. | journal=J Infect | year= 1980 | volume= 2 | issue= 4 | pages= 360-4 | pmid=7185934 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7185934 }} </ref> and 17-34% if associated with [[HIV]]<ref name="pmid10908256">{{cite journal| author=Hakim JG, Ternouth I, Mushangi E, Siziya S, Robertson V, Malin A| title=Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients. | journal=Heart | year= 2000 | volume= 84 | issue= 2 | pages= 183-8 | pmid=10908256 | doi= | pmc=PMC1760932 | url= }} </ref>. A 2months course of [[isoniazid]], [[pyrazinamide]], [[rifampicin]], and [[ethambutol]] followed by 4months course of [[isoniazid]] and [[rifampicin]] is shown to be effective<ref name="pmid2106816">{{cite journal| author=Cohn DL, Catlin BJ, Peterson KL, Judson FN, Sbarbaro JA| title=A 62-dose, 6-month therapy for pulmonary and extrapulmonary tuberculosis. A twice-weekly, directly observed, and cost-effective regimen. | journal=Ann Intern Med | year= 1990 | volume= 112 | issue= 6 | pages= 407-15 | pmid=2106816 | doi= | pmc= | url= }} </ref>. Short course chemotherapy is beneficial in [[HIV]] infected patients<ref name="pmid7862181">{{cite journal| author=Perriëns JH, St Louis ME, Mukadi YB, Brown C, Prignot J, Pouthier F et al.| title=Pulmonary tuberculosis in HIV-infected patients in Zaire. A controlled trial of treatment for either 6 or 12 months. | journal=N Engl J Med | year= 1995 | volume= 332 | issue= 12 | pages= 779-84 | pmid=7862181 | doi=10.1056/NEJM199503233321204 | pmc= | url= }} </ref>. | ||
===Empirical | ====Empirical Anti-Tuberculosis therapy==== | ||
It should be noted 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.<ref name="Mayosi-2005">{{Cite journal | last1 = Mayosi | first1 = BM. | last2 = Burgess | first2 = LJ. | last3 = Doubell | first3 = AF. | title = Tuberculous pericarditis. | journal = Circulation | volume = 112 | issue = 23 | pages = 3608-16 | month = Dec | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.543066 | PMID = 16330703 }}</ref> In developed countries where TB is not endemic, antituberculous therapy should generally not be initiated empirically in the absence of definitive diagnosis.<ref name="Soler-Soler-2001">{{Cite journal | last1 = Soler-Soler | first1 = J. | last2 = Sagristà-Sauleda | first2 = J. | last3 = Permanyer-Miralda | first3 = G. | title = Management of pericardial effusion. | journal = Heart | volume = 86 | issue = 2 | pages = 235-40 | month = Aug | year = 2001 | doi = | PMID = 11454853 }}</ref> | It should be noted 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.<ref name="Mayosi-2005">{{Cite journal | last1 = Mayosi | first1 = BM. | last2 = Burgess | first2 = LJ. | last3 = Doubell | first3 = AF. | title = Tuberculous pericarditis. | journal = Circulation | volume = 112 | issue = 23 | pages = 3608-16 | month = Dec | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.543066 | PMID = 16330703 }}</ref> In developed countries where TB is not endemic, antituberculous therapy should generally not be initiated empirically in the absence of definitive diagnosis.<ref name="Soler-Soler-2001">{{Cite journal | last1 = Soler-Soler | first1 = J. | last2 = Sagristà-Sauleda | first2 = J. | last3 = Permanyer-Miralda | first3 = G. | title = Management of pericardial effusion. | journal = Heart | volume = 86 | issue = 2 | pages = 235-40 | month = Aug | year = 2001 | doi = | PMID = 11454853 }}</ref> | ||
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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 noted 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]
American Thoracic Society, CDC, and Infectious Diseases Society of America recommends use of corticosteroids (prednisone) as adjunctive therapy for tuberculous pericarditis during the first 11 weeks of antituberculosis therapy[9]. Following are the dosage recommendations:
- Adults: Prednisone 60 mg/day (or the equivalent dose of prednisolone) given for 4 weeks, followed by 30 mg/day for 4 weeks, 15 mg/day for 2 weeks, and finally 5 mg/day for week 11 (the final week)
- Children: doses should be proportionate to their weight, beginning with about 1 mg/kg body weight and decreasing the dose as described for adults.
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.