Empiric Therapy Regimens
Empiric therapeutic regimens for infectious pericarditis are outlined below, including those for bacterial infections, viral infections, fungal infections, and mycobacterial infections. [1, 2, 3, 4, 5, 6, 7, 8]
Bacterial infection
Immunocompetent patient
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Vancomycin 15 mg/kg IV q12h plus ceftriaxone 1-2 g IV q12h
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Duration of therapy: Optimal treatment duration is not well studied and varies per patient; look for symptomatic and electrocardiographic/echocardiographic improvement
Immunocompromised patient, nosocomial infection, and/or critically ill patient
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Vancomycin 15 mg/kg IV q12h plus cefepime 2 g IV q12h plus ciprofloxacin 400 mg IV q24h
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Duration of therapy: Optimal treatment duration is not well studied and varies per patient; look for symptomatic and electrocardiographic/echocardiographic improvement
Viral infection
First-line treatment
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Ibuprofen 300-800 mg PO q8h plus colchicine 0.6 mg PO BID
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Duration of therapy: Optimal treatment duration is not well studied and varies per patient; NSAIDs are generally used for 1-2 weeks, with colchicine continued for up to 3 months to reduce risk of recurrence. [9]
Second-line treatment (refractory cases or intolerant of NSAIDs)
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Prednisone 0.25-1 mg/kg PO daily plus colchicine 0.6 mg PO BID
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Duration of therapy: Optimal treatment duration is not well studied and varies per patient; prednisone may be tapered after 2-4 weeks if patients are asymptomatic, with colchicine continued for up to 3 months to reduce risk of recurrence
Fungal infection
First-line treatment
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Micafungin 100 mg IV q24h or
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Anidulafungin 200 mg loading dose, then 100 mg IV q24h or
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Caspofungin 70 mg loading dose, then 50 mg IV q24h
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Duration of therapy: Optimal treatment duration is not well studied and varies per patient; look for symptomatic and electrocardiographic/echocardiographic improvement; surgical or percutaneous drainage typically required
Second-line treatment (or if patient is critically)
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Liposomal amphotericin B IV 3-5 mg/kg daily
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Duration of therapy: Optimal treatment duration is not well studied and varies per patient; surgical or percutaneous drainage typically required
Mycobacterial infection
4-drug regimen
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Isoniazid 300 mg PO q24h plus
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Rifampin 600 mg PO q24h plus
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Pyrazinamide 15-30 mg/kg PO daily (up to 2 g/day) given as a single dose plus
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Ethambutol 15-25 mg/kg PO q24h or streptomycin 20-40 mg/kg (up to 1 g) IM q24h
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Duration of therapy: 4-drug regimen for 8 weeks, then daily isoniazid and rifampin only for 4 months
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Optional: Prednisone 1-2 mg/kg/day for 5-7 days, then progressively tapered to discontinuation in 6-8 weeks