n Cardiovascular Journal of South Africa - Experience with adjunctive corticosteroids in managing tuberculous pericarditis : cardiovascular topics
|Article Title||Experience with adjunctive corticosteroids in managing tuberculous pericarditis : cardiovascular topics|
|© Publisher:||Clinics Cardive Publishing|
|Journal||Cardiovascular Journal of South Africa|
|Author||Helmuth Reuter, Lesley J. Burgess, Vernon J. Louw and Anton F. Doubell|
|Publication Date||Sep 2006|
|Pages||233 - 238|
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. <BR>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. <BR>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. <BR>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.
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