title: Effectiveness of intrapericardial administration of streptokinase in purulent pericarditis.
abstract: OBJECTIVE
  Purulent pericarditis is very rare. However, among patients suffering from this disease the mortality rate is very high. The aim of this study was to evaluate the effectiveness and side effects of intrapericardial streptokinase administration in patients with confirmed purulent pericarditis.
  
  
  METHODS
  Three patients, one 50-year-old man and two women aged 64 and 40 years, who were admitted to the intensive care unit (ICU) due to purulent pericarditis, entered the study. In all three cases a subxiphoid pericardiotomy followed by insertion of a drainage line into the pericardial space was performed. Antibiotic therapy was started immediately on admission to the hospital. Despite continued antibiotic therapy in all three patients, daily drainage from the pericardium--during several days after surgery--staggered between 50-200 ml/day. Due to considerable purulent pericardial drainage loculations and/or fibrin deposits confirmed by echocardiography, streptokinase (500,000 IU dissolved in 50 ml of normal saline) was administered into the pericardial space over 10 min, using the previously inserted drainage catheter. This regimen was repeated after 12 and 24 h. The total dose of streptokinase was 1,500,000 IU.
  
  
  RESULTS
  The clinical effect of intrapericardial streptokinase administration was excellent. Several days after intrapericardial administration of streptokinase, drainage of purulent pericardial fluid stopped. No complications associated with intrapericardial streptokinase administration were observed. In the follow-up echocardiography (in two patients repeated 6 and 9 months after delivery of streptokinase), pericardial fluid and echocardiographic signs of pericardial constriction were not observed.
  
  
  CONCLUSIONS
  Intrapericardial administration of streptokinase in purulent pericarditis is effective and safe.
authors.affiliation: Intensive Care Unit, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
authors.forename: Witold Zbyszek
authors.initials: WZ
authors.lastname: Tomkowski
authors.forename: Renata
authors.initials: R
authors.lastname: Gralec
authors.forename: Paweł
authors.initials: P
authors.lastname: Kuca
authors.forename: Janusz
authors.initials: J
authors.lastname: Burakowski
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Orłowski
authors.forename: Marcin
authors.initials: M
authors.lastname: Kurzyna
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D010493:Pericarditis / Q000145:classification / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012720:Severity of Illness Index; D013300:Streptokinase / Q000008:administration & dosage*; D013492:Suppuration / Q000000981:diagnostic imaging / Q000188:drug therapy; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D013300:Streptokinase