What is the role of steroids in the treatment of tuberculous pericarditis?

Updated: Apr 02, 2019
  • Author: Sean Spangler, MD; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

Controversy exists regarding the use of steroids in the treatment of tuberculous pericarditis. The ESC 2004 guideline advises using corticosteroid therapy only in patients with secondary tuberculous pericarditis, and only as an adjunct to tuberculostatic treatment. A meta-analysis of patients with effusive and constrictive TBC pericarditis found that tuberculostatic treatment, combined with steroids, might be associated with fewer deaths, less frequent need for pericardiocentesis or pericardiectomy. [24]

The 2015 ESC updated guidelines indicate adjunctive steroids may be considered in human immunodeficiency virus (HIV)-negative TB pericarditis, but these agents should be avoided in HIV-associated TB (class IIb, level C evidence). [3] Regarding empiric anti-tuberculosis treatment in patients, ESC 2015 indicates the following (all level C evidence) [3] :

  • Endemic regions: Recommended for exudative pericardial effusion after other causes have been ruled out (class I)
  • Non-endemic regions: Not recommended in the absence of a diagnosis of tuberculous pericarditis after systematic investigation (class III)

In the setting of tuberculous pericardial constriction, 6 months of standard antituberculosis agents is recommended (class I, level C evidence). [3] If the patient's condition does not improve or deteriorates after 4-8 weeks of antituberculosis therapy, pericardiectomy is recommended. (class I, level C evidence). [3]

Use of adjunctive prednisolone in patients with acquired immunodeficiency syndrome (AIDS) may reduce mortality in this population.


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