Experience with adjunctive corticosteriods in managing tuberculous pericarditis
Date
2006-10
Authors
Reuter, Helmuth
Burgess, Lesley J.
Louw, Vernon J.
Doubell, Anton F.
Journal Title
Journal ISSN
Volume Title
Publisher
Clinics Cardiv Publishing
Abstract
Objectives: To compare the efficacy of intrapericardial
corticosteroid therapy to either oral corticosteroid therapy
or intrapericardial placebo in addition to closed pericardiocentesis
and anti-tuberculous therapy in patients
with tuberculous pericarditis.
Methods: Patients with large pericardial effusions requiring
pericardiocentesis were included. A short-course
anti-tuberculous regimen was initiated and patients were
randomised to one of three treatment groups: 200 mg
intrapericardial triamcinolone hexacetonide; oral prednisone
plus intrapericardial placebo; or 5 ml intrapericardial
0.9% saline (placebo). Patients were followed up
for at least one year.
Results: Fifty-seven patients were included in the study;
21 tested HIV positive (36.8%). Forty (70.0%) had
microbiological and/or histological evidence of tuberculosis,
and 17 (30.0%) had a diagnosis based on clinical
and laboratory data. All patients responded well to initial
pericardiocentesis. However, nine patients (16.0%) were
lost to follow up. The hospitalisation duration for the
steroid groups was shorter than for the placebo group.
This difference was not significant. Complications were
similar for all arms.
Conclusions: Intrapericardial and systemic corticosteroids
were well tolerated but did not improve the clinical
outcome. The standard six-month regimen was effective
regardless of HIV infection. The potential benefits from
adjunctive corticosteroids in the management of effusive
tuberculous pericarditis could not be demonstrated in
this three-year study.
Description
The original publication is available at http://www.cvja.co.za/
Keywords
Adjunctive corticosteroids, Tuberculous pericarditis -- Treatment
Citation
Reuter, H., Burgess, L.J., Louw, V.J. & Doubell, A.F. 2006. Experience with adjunctive corticosteroids in managing tuberculous pericarditis. Cardiovaascular Journal of South Africa, 17(5):233-238