Acute pericarditis: symptom control, recurrence prevention and drainage
THE CONTEXT
Management includes anti-inflammatory treatment for pain and colchicine for symptom relief and prevention of relapses. Purulent pericarditis requires antimicrobial treatment and drainage.
Drug treatment
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Aspirin: Pain usually responds to 600 mg six times daily.
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Indomethacin: A more potent anti-inflammatory agent may be required; the stated regimen is 50 mg three times daily.
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Colchicine: The stated regimen is 0.5 mg twice daily, reduced to once daily if body weight is less than 70 kg.
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Recurrence prevention: Colchicine is very effective at relieving symptoms and prevents relapsing episodes when taken for 3 months from symptom onset.
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Glucocorticoids: These are no longer recommended for this condition.
Course and cause-specific management
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Viral pericarditis: Recovery usually occurs within a few days or weeks, although recurrences may occur as chronic relapsing pericarditis.
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Purulent pericarditis: Treatment requires antimicrobial therapy and pericardiocentesis, with surgical drainage if necessary.