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Effectiveness of intrapericardial administration of streptokinase in purulent pericarditis
Witold Zbyszek Tomkowski1, Renata Gralec, Paweł Kuca
1Intensive Care Unit, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
Insights
Intrapericardial streptokinase effectively treated purulent pericarditis in three patients by stopping drainage and preventing constriction. This method proved safe and beneficial for managing this rare, high-mortality condition.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Procedures
Background:
- Purulent pericarditis is a rare but often fatal condition.
- Effective treatment strategies for purulent pericarditis are limited.
- This study evaluates a novel approach using streptokinase in purulent pericarditis.
Observation:
- Three patients with purulent pericarditis received intrapericardial streptokinase via a drainage catheter.
- Despite antibiotic therapy and drainage, significant purulent fluid persisted.
- Echocardiography revealed loculations and fibrin deposits, indicating a need for enhanced treatment.
Findings:
- Intrapericardial streptokinase administration led to an excellent clinical response.
- Purulent pericardial fluid drainage ceased within days of treatment.
- No adverse events or complications were observed during or after streptokinase administration.
- Follow-up echocardiography showed no recurrence of pericardial fluid or constriction.
Implications:
- Intrapericardial streptokinase is a safe and effective adjunctive therapy for purulent pericarditis.
- This approach can resolve purulent pericardial effusions and prevent constrictive sequelae.
- Further research may establish this as a standard treatment for refractory purulent pericarditis.
Background And Purpose:
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.
Patients And 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.
Conclusion:
Intrapericardial administration of streptokinase in purulent pericarditis is effective and safe.
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