What are the differences in treatment for endocarditis vs pericarditis?

From the Guidelines

Endocarditis and pericarditis require distinct treatment approaches due to their different pathophysiologies, with endocarditis focusing on prolonged antimicrobial therapy and pericarditis targeting inflammation with NSAIDs and colchicine. The treatment of endocarditis typically involves 4-6 weeks of intravenous antibiotics, such as vancomycin, ceftriaxone, gentamicin, or ampicillin, depending on the causative organism 1. In contrast, pericarditis treatment primarily involves NSAIDs, such as ibuprofen or indomethacin, for 1-2 weeks, followed by a gradual taper, and colchicine to reduce recurrence risk 1.

• Key differences in treatment approaches:
  • Endocarditis: prolonged antimicrobial therapy, surgical intervention for complications
  • Pericarditis: anti-inflammatory therapy with NSAIDs and colchicine, pericardiocentesis for cardiac tamponade or purulent pericarditis
• Recent guidelines recommend the use of colchicine as first-line therapy for acute pericarditis, in addition to aspirin or NSAIDs, to reduce recurrence risk 1.
• The choice of antibiotic regimen for endocarditis depends on the causative organism, with vancomycin and ceftriaxone being common options for MRSA and streptococcal infections, respectively 1.
• Pericardiocentesis may be necessary for cardiac tamponade or purulent pericarditis, and the pericardial fluid should be sent for chemistry, microbiology, and cytology analysis 1. The most recent and highest quality study, published in 2015, recommends the use of colchicine as first-line therapy for acute pericarditis, in addition to aspirin or NSAIDs, to reduce recurrence risk 1.

From the FDA Drug Label

Serious infections due to susceptible strains of streptococci (including S. pneumoniae) -septicemia, empyema, pneumonia, pericarditis, endocarditis and meningitis 12 to 24 million units/day depending on the infection and its severity administered in equally divided doses every 4 to 6 hours Serious infections due to susceptible strains of staphylococci-septicemia, empyema, pneumonia, pericarditis, endocarditis and meningitis 5 to 24 million units/day depending on the infection and its severity administered in equally divided doses every 4 to 6 hours.

The main differences in treatment for endocarditis vs pericarditis are:

• The dosage of penicillin G may vary depending on the severity of the infection and the causative organism.
• Endocarditis may require a longer duration of treatment, typically 4 weeks, whereas pericarditis treatment duration is not explicitly stated in the label.
• Both conditions can be treated with penicillin G, with dosages ranging from 5 to 24 million units/day for staphylococcal infections and 12 to 24 million units/day for streptococcal infections, administered in equally divided doses every 4 to 6 hours 2.

From the Research

Treatment Differences

The treatment for endocarditis and pericarditis differs significantly.

• For endocarditis, antibiotic therapy is the primary treatment, with the specific regimen depending on the causative organism 3, 4.
• In contrast, pericarditis treatment focuses on relieving symptoms and addressing the underlying cause, with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine being common first-line therapies 5.

Antibiotic Therapy for Endocarditis

• The choice of antibiotic therapy for endocarditis depends on the causative organism, with streptococci and staphylococci being the most common causes 3, 4.
• For example, patients with penicillin-sensitive viridans or nonenterococcal group D streptococcal endocarditis may be treated with aqueous penicillin G alone or in combination with streptomycin 3.
• In cases of Staphylococcus aureus endocarditis, a semisynthetic penicillin or cephalosporin is recommended 3, 4.

Treatment of Pericarditis

• Pericarditis treatment may involve NSAIDs, colchicine, or corticosteroids, depending on the severity and underlying cause of the disease 5.
• In cases of pericardial effusion, urgent pericardial fluid drainage may be necessary to prevent tamponade 5.
• Constrictive pericarditis may require surgical intervention, such as pericardiectomy, in chronic cases 5.

Diagnostic Approaches

• Endocarditis diagnosis often involves blood cultures and echocardiography, with consideration of risk factors such as prior endocarditis, structural heart damage, and IV drug use 6, 7.
• Pericarditis diagnosis relies on clinical presentation, electrocardiography, and imaging studies, such as echocardiography or computed tomography 5.