Treatment of Pericarditis

The treatment of patients with acute uncomplicated pericarditis is nonsteroidal anti-inflammatory drugs (NSAIDS). NSAIDS are aimed at relieving the symptoms and the inflammatory response.

Colchicine in conjunction with NSAIDS is an emerging therapy for the initial treatment and prevention of recurrent pericarditis. Colchicine is especially useful in patients who have a history of renal dysfunction or cannot tolerate NSAIDS.

Some patients with acute pericarditis will develop a recurrence after a course of nonsteroidal anti-inflammatory drugs and/or colchicine drug treatment, but usually respond to a second course of therapy. Occasionally, multiple recurrences occur and a course of systemic corticosteroids is required. Steroids should be used only when necessary because of their potential side effects. Every effort should be made to taper and discontinue their use as quickly as possible.

The treatment of acute pericarditis from other etiologies often differs from that caused by a virus. Patients with connective tissue disorders such as systemic lupus erythematosus usually require corticosteroid therapy. In contrast, patients with uremic pericarditis on chronic hemodialysis are best treated by an increase in the frequency or intensity of the dialysis. Antibiotics penetrate the pericardium poorly, consequently, patients with acute or chronic pericarditis due to bacterial infection almost always also require pericardial drainage or removal to achieve a cure and prevent / treat tamponade or constriction.
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