eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology
Pericarditis, Viral: Treatment & Medication
Updated: Jul 24, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
Management is conservative (expectant) and symptom specific.
- Bed rest and the use of anti-inflammatory agents are mainstays of initial therapy.
- Aggressive pain control may be necessary in some patients, although most cases respond to salicylates or nonsteroidal anti-inflammatory drugs (NSAIDs).
- Corticosteroid therapy is rarely indicated. Consider this option only when NSAIDs are unsuccessful and a bacterial etiology has clearly been excluded. Although corticosteroid therapy might dramatically reduce symptoms, no convincing evidence of any long-term benefits has been reported. Moreover, corticosteroid therapy may increase the risk of recurrence.
- A prospective randomized trial reported a significant reduction in the rate of recurrence with colchicine therapy in patients with a first episode of acute pericarditis.3 However, this study involved mainly adult patients with a wide spectrum of etiologies, and diarrhea necessitated discontinuation of colchicine in numerous patients.
- Resolution of effusion may occur within several days to weeks after initiating anti-inflammatory drugs; However, patients should be closely observed for the development of pericardial tamponade as a part of their initial care.
- Pericardiocentesis is indicated when the etiology is in doubt and is essential in suspected tamponade.
- Occasionally, intravenous immunoglobulin has been used to treat patients who develop chronic pericarditis with satisfactory results.
Surgical Care
- Place a pericardial drainage catheter.
- Pericardiectomy, the surgical creation of a pericardial window needed in refractory cases to facilitate open drainage, is rarely required to manage chronic recurrent cases. Recently, video-assisted thoracoscopic window has been used in adult patients for diagnosis and management of pericardial effusions.
Consultations
- Pediatric cardiologist
- Radiologist
- Family physician
- Psychologist
- School teacher
- Specialist nurse
- Pharmacist
- Dietitian
Diet
Viral pericarditis requires no special diet.
Activity
Reduce the patient's activity to the level he or she can tolerate.
Medication
Bed rest and use of anti-inflammatory agents are the mainstays of initial therapy. Aggressive pain control may be necessary in some patients; however, most cases respond to salicylates or NSAIDs. Although corticosteroid therapy is rarely indicated, consider this course when NSAIDs are unsuccessful and when a bacterial etiology is clearly excluded.
Corticosteroids may dramatically reduce symptoms, but no convincing evidence suggests any long-term benefit. Anti-inflammatory therapy (eg, with aspirin, indomethacin) may continue for several months. After therapy is discontinued, 15-30% of patients may have a relapse. The optimal method for prevention is not fully established, but accepted modalities include NSAIDs, corticosteroids, immunosuppressive agents, and pericardiectomy. Colchicine has also been used in some patients, with a good response.
NSAIDs
These drugs have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action inhibits cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may also occur, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.
Ibuprofen (Advil, Motrin, Ibuprin)
Propionic acid derivative that reduces formation of inflammatory mediators by enzyme inhibition.
Adult
1.6-2.4 g/d PO divided qid
Pediatric
10 mg/kg PO qid; not to exceed 2.4 g/d
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; may decrease effect of antihypertensive agents because of fluid retention; may decrease effects of beta-blockers, hydralazine, and captopril; may decrease effects of loop diuretics with coadministration; coadministration with anticoagulants may increase PT (monitor and watch for signs of bleeding); may increase serum lithium levels and risk of methotrexate and phenytoin toxicity; probenecid may increase toxicity of NSAIDs
Documented hypersensitivity; aspirin hypersensitivity; breastfeeding; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Pregnancy category D in third trimester; caution in CHF, hypertension, and decreased renal and hepatic function; anticoagulation abnormalities or during anticoagulant therapy
Naproxen (Aleve, Anaprox, Naprosyn)
Propionic acid derivative that reduces formation of inflammatory mediators by enzyme inhibition.
Adult
0.5-1 g/d PO qd or divided bid
Pediatric
<2 years: Not established
>2 years: 10 mg/kg/d PO divided bid
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; may decrease effect of antihypertensive agents because of fluid retention; may decrease effects of beta-blockers, hydralazine, and captopril; may decrease effects of loop diuretics; coadministration with anticoagulants may increase PT (monitor and watch for signs of bleeding); may increase serum lithium levels and risk of methotrexate and phenytoin toxicity; probenecid may increase toxicity of NSAIDs
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; aspirin hypersensitivity; breastfeeding; coagulation defects
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Pregnancy category D in third trimester; caution in CHF and hypertension; acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia rarely occurs, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation
Diclofenac sodium (Cataflam)
Possesses properties similar to propionic acid derivatives and reduces formation of inflammatory mediators by enzyme inhibition. Cataflam tabs are immediate-release.
Adult
75-150 mg/d PO divided bid/tid
Pediatric
1-3 mg/kg/d PO divided bid/tid; not to exceed 25 mg/d for children aged 2-5 y, and 50 mg/d for children aged 6-10 y
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; may decrease effects of beta-blockers, hydralazine, and captopril; fluid retention caused by NSAIDs may decrease effects of loop diuretics with coadministration; coadministration with anticoagulants may increase PT (monitor and watch for signs of bleeding); may increase serum lithium levels and risk of methotrexate and phenytoin toxicity; probenecid may increase toxicity of NSAIDs
Documented hypersensitivity; aspirin hypersensitivity; breastfeeding; coagulation defects; peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, and patients at high risk for bleeding; perioperative pain with CABG
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Pregnancy category D in third trimester; acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion; low WBC counts rarely occur and usually return to normal in ongoing therapy; discontinuation of therapy may be necessary if persistent leukopenia, granulocytopenia, or thrombocytopenia develops
Indomethacin (Indocin)
Behaves like propionic acid derivatives and inhibits formation of inflammatory mediators. Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation; inhibits prostaglandin synthesis.
Adult
50-200 mg/d PO divided tid/qid
Pediatric
0.3-3 mg/kg/d PO divided tid/qid
Coadministration with aspirin increases risk of serious NSAID-related adverse effects; may decrease effects of beta-blockers, hydralazine, and captopril; fluid retention caused by NSAIDs may decrease diuretic effects of furosemide and thiazides; coadministration with anticoagulants may prolong PT (monitor and watch for signs of bleeding); may increase risk of methotrexate toxicity, which can manifest as stomatitis, bone marrow suppression, or nephrotoxicity; coadministration may increase phenytoin levels; probenecid may increase toxicity of NSAIDS
Documented hypersensitivity; aspirin hypersensitivity; breastfeeding; coagulation defects; peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, and patients at high risk for bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Pregnancy category D if used >48 h or after 34 weeks' gestation; use with care in renal, cardiac, and hepatic impairment; has more anti-inflammatory action but more adverse effects than other drugs; reversible leukopenia may occur (discontinue if leukopenia, granulocytopenia, or thrombocytopenia persists)
Corticosteroids
These drugs have anti-inflammatory and immunosuppressive properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.
Prednisolone (Pediapred, Orapred, Econopred)
Use restricted to resistant cases that do not respond to nonsteroidal medications. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.
Adult
10-60 mg PO every am
Pediatric
1-2 mg/kg/d PO every am
Increases risk of GI bleeding with phenytoin, carbamazepine, barbiturates, and rifampin decrease effects of corticosteroids; coadministration with estrogens may decrease prednisone clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; monitor for hypokalemia with coadministration of diuretics
Documented hypersensitivity; viral, fungal, or tubercular skin lesions; peptic ulcer disease, hepatic dysfunction, connective tissue infections, GI bleeding, or ulceration
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Only essential use suggested because these agents may increase recurrence risk; caution in hyperthyroidism, osteoporosis, cirrhosis, nonspecific ulcerative colitis, peptic ulcer, diabetes mellitus, and myasthenia gravis; do not stop abruptly if used for >1 wk; may cause GI upset, peptic ulcer disease, acute pancreatitis, candidiasis, myopathy, psychosis, hypertension, hyperglycemia, osteoporosis, growth delay, and cataracts
More on Pericarditis, Viral |
| Overview: Pericarditis, Viral |
| Differential Diagnoses & Workup: Pericarditis, Viral |
 Treatment & Medication: Pericarditis, Viral |
| Follow-up: Pericarditis, Viral |
| Multimedia: Pericarditis, Viral |
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Further Reading
Keywords
viral pericarditis, bacterial pericarditis, myopericarditis, constrictive pericarditis, inflammation of the pericardium, viral pericarditis, tamponade, myocarditis, elevated nonpulsatile jugular venous pulse, tachycardia, hepatomegaly, asthma, emphysema, pleural effusion, chronic idiopathic pericarditis, congestive heart failure, coxsackievirus B, echovirus, adenovirus, influenza virus, mumps virus, varicella virus, Epstein-Barr virus, cytomegalovirus, viral hepatitis B, human immunodeficiency virus, HIV, human herpesvirus 6, parvovirus B1
