Interventions for treating tuberculous pericarditis.
BACKGROUND
Tuberculous pericarditis - tuberculosis infection of the pericardial membrane (pericardium) covering the heart - is becoming more common. The infection can result in fluid around the heart or fibrosis of the pericardium, which can be fatal.


OBJECTIVE
In people with tuberculous pericarditis, to evaluate the effects on death, life-threatening conditions, and persistent disability of: (1) 6-month antituberculous drug regimens compared with regimens of 9 months or more; (2) corticosteroids; (3) pericardial drainage; and (4) pericardiectomy.


METHODS
We searched the Cochrane Infectious Diseases Group trials register (June 2002), the Cochrane Controlled Trials Register (Issue 2, 2002), MEDLINE (1966 to June 2002), EMBASE (1980 to May 2002), and checked the reference lists of existing reviews. We also contacted organizations and individuals working in the field.


METHODS
Randomized and quasi-randomized controlled trials of treatments for tuberculous pericarditis.


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


RESULTS
Four trials met the inclusion criteria, with a total of 469 participants. Treatments tested were adjuvant steroids and surgical drainage. Two trials with a total of 383 participants tested adjuvant steroids in participants with suspected tuberculous pericarditis in the pre-HIV era. Fewer participants died in the intervention group, but numbers were small (relative risk [RR] 0.65; 95% confidence interval [CI] 0.36 to 1.16, n = 350). One small trial tested steroids in HIV positive participants with effusion showed a similar pattern (RR 0.50; 95% CI 0.19 to 1.28, n = 58). One trial examined open surgical drainage compared with conservative management, and showed surgery relieved cardiac tamponade.


CONCLUSIONS
Steroids could have important clinical benefits, but the trials published to date are too small to demonstrate an effect. This requires large placebo controlled trials. Subgroup analysis could explore whether effusion or fibrosis modify the effects. Therapeutic pericardiocentesis under local anaesthesia and pericardiectomy also require further evaluation.
Mayosi
B M
BM
The Cardiac Clinic, E25 Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa. bmayosi@uctgsh1.uct.ac.za
Ntsekhe
M
M
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; D016032:Randomized Controlled Trials as Topic
D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents