Interventions for treating tuberculous pericarditis.
BACKGROUND
Tuberculous (TB) pericarditis is becoming more common. The infection can result in fluid around the heart, which can be fatal.


OBJECTIVE
To evaluate evidence from trials about the effects of medical and surgical treatments for TB pericarditis on death and life-threatening conditions.


METHODS
The Cochrane Infectious Diseases Group trials register, the Cochrane controlled trials register, Medline, Embase and reference lists of articles; contact with experts in the field.


METHODS
Randomised and quasi-randomised trials of treatments for TB pericarditis.


METHODS
Two reviewers independently assessed trial quality and extracted data. Meta-analysis using fixed effects models calculated summary statistics, provided there was no significant heterogeneity, and expressed results as relative risk.


RESULTS
Three trials met the inclusion criteria, with a total of 411 participants. Treatments were adjuvant steroids and surgical drainage. Two small trials tested steroids. There were fewer deaths (all causes) in the intervention group, but the numbers were small and the result could have occurred by chance (relative risk [RR] 0.65, 95% confidence interval [CI] 0.36 to 1.16, n = 350). In one trial studying patients with effusion, "cure" was higher in the steroid group (alive and free of disability at 2 years (RR 0.69, 95% CI 0.29 to 0.80, n = 221). One trial examined open surgical drainage compared with conservative management, and showed no impact of surgery on death, but a protective effective against cadiac tamponade (RR 0.04, 95% CI 0.00 to 0.64).


CONCLUSIONS
Steroids have potentially large impacts on survival, but trials are too small to test this. We believe further placebo controlled trials of steroids are warranted, exploring whether the presence of effusion or fibrosis modifies effects. Surgical options also require further evaluation.
Mayosi
B M
BM
Department of Cardiovascular Medicine, John Radcliffe Hospital, Level 5, Headley Way, Oxford, Oxfordshire, UK, OX3 9DU. bongani.mayosi@wolfson.oxford.ac.uk
Volmink
J A
JA
Commerford
P J
PJ
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D004322:Drainage; D006801:Humans; D010492:Pericardiectomy; D010495:Pericarditis, Tuberculous / Q000188:drug therapy* / Q000601:surgery*; D010496:Pericardium / Q000601:surgery
D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents