Pericarditis Empiric Therapy 

Pericarditis Empiric Therapy 

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Empiric therapeutic regimens for infectious pericarditis are outlined below, including those for bacterial infections, viral infections, fungal infections, and mycobacterial infections. [1, 2, 3, 4, 5, 6, 7, 8]

Immunocompetent patient

Vancomycin 15 mg/kg IV q12h plus ceftriaxone 1-2 g IV q12h

Duration of therapy: Optimal treatment duration is not well studied and varies per patient; look for symptomatic and electrocardiographic/echocardiographic improvement

Immunocompromised patient, nosocomial infection, and/or critically ill patient

Vancomycin 15 mg/kg IV q12h plus cefepime 2 g IV q12h plus ciprofloxacin 400 mg IV q24h

Duration of therapy: Optimal treatment duration is not well studied and varies per patient; look for symptomatic and electrocardiographic/echocardiographic improvement

First-line treatment

Ibuprofen 300-800 mg PO q8h plus colchicine 0.6 mg PO BID

Duration of therapy: Optimal treatment duration is not well studied and varies per patient; NSAIDs are generally used for 1-2 weeks, with colchicine continued for up to 3 months to reduce risk of recurrence. [9]

Second-line treatment (refractory cases or intolerant of NSAIDs)

Prednisone 0.25-1 mg/kg PO daily plus colchicine 0.6 mg PO BID

Duration of therapy: Optimal treatment duration is not well studied and varies per patient; prednisone may be tapered after 2-4 weeks if patients are asymptomatic, with colchicine continued for up to 3 months to reduce risk of recurrence

First-line treatment

Micafungin 100 mg IV q24h or

Anidulafungin 200 mg loading dose, then 100 mg IV q24h or

Caspofungin 70 mg loading dose, then 50 mg IV q24h

Duration of therapy: Optimal treatment duration is not well studied and varies per patient; look for symptomatic and electrocardiographic/echocardiographic improvement; surgical or percutaneous drainage typically required

Second-line treatment (or if patient is critically)

Liposomal amphotericin B IV 3-5 mg/kg daily

Duration of therapy: Optimal treatment duration is not well studied and varies per patient; surgical or percutaneous drainage typically required

4-drug regimen

Isoniazid 300 mg PO q24h plus

Rifampin 600 mg PO q24h plus

Pyrazinamide 15-30 mg/kg PO daily (up to 2 g/day) given as a single dose plus

Ethambutol 15-25 mg/kg PO q24h or streptomycin 20-40 mg/kg (up to 1 g) IM q24h

Duration of therapy: 4-drug regimen for 8 weeks, then daily isoniazid and rifampin only for 4 months

Optional: Prednisone 1-2 mg/kg/day for 5-7 days, then progressively tapered to discontinuation in 6-8 weeks

Pankuweit S, Ristic AD, Seferovic PM, Maisch B. Bacterial pericarditis: diagnosis and management. Am J Cardiovasc Drugs. 2005. 5(2):103-12. [Medline].

Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmüller R, Adler Y, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J. 2004 Apr. 25(7):587-610. [Medline].

Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Mar 1. 48(5):503-35. [Medline].

Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008 Feb 1. 46(3):327-60. [Medline].

Imazio M, Cecchi E, Demichelis B, Chinaglia A, Ierna S, Demarie D, et al. Myopericarditis versus viral or idiopathic acute pericarditis. Heart. 2008 Apr. 94(4):498-501. [Medline].

Mandell GL et al. Pericarditis. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Churchill Livingstone; 2010. Vol 1: Chapter 81.

Snyder MJ, Bepko J, White M. Acute pericarditis: diagnosis and management. Am Fam Physician. 2014 Apr 1. 89(7):553-60. [Medline].

Imazio M, Adler Y. Treatment with aspirin, NSAID, corticosteroids, and colchicine in acute and recurrent pericarditis. Heart Fail Rev. 2013 May. 18(3):355-60. [Medline].

Imazio M, Gaita F. Acute and Recurrent Pericarditis. Cardiol Clin. 2017 Nov. 35 (4):505-513. [Medline].

Medscape Reference. WebMD. Available at http://www.medscape.com.

Ryan C Maves, MD, FACP, FCCP, FIDSA Program Director, Infectious Diseases Fellowship, Naval Medical Center San Diego; Associate Professor of Medicine, Uniformed Services University of the Health Sciences

Ryan C Maves, MD, FACP, FCCP, FIDSA is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Armed Forces Infectious Diseases Society, HIV Medicine Association, Infectious Diseases Society of America, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Kelley Struble, DO Fellow, Department of Infectious Diseases, University of Oklahoma College of Medicine

Kelley Struble, DO is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Pericarditis Empiric Therapy 

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