Tuberculous pericarditis medical therapy


 * Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

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%. At present it is 8-17% and 17-34% if associated with HIV. A 2months course of isoniazid, pyrazinamide, rifampicin, and ethambutol followed by 4months course of isoniazid and rifampicin is shown to be effective. Short course chemotherapy is beneficial in HIV infected patients.

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. 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.