Duration of Prophylaxis for Spontaneous Bacterial Peritonitis (SBP) After an Episode
For acute pericarditis, colchicine should be continued for at least 3 months as prophylaxis against recurrence, while NSAIDs or aspirin should be tapered after 1-2 weeks once symptoms resolve and CRP normalizes. 1, 2, 3
First-Line Treatment Duration
- The European Society of Cardiology recommends colchicine as first-line prophylaxis for pericarditis with a treatment duration of 3 months 1, 2
- Colchicine dosing should be weight-adjusted: 0.5 mg once daily for patients <70 kg and 0.5 mg twice daily for patients ≥70 kg 1, 4
- NSAIDs or aspirin should be used for 1-2 weeks and then tapered based on symptom resolution and CRP normalization 1, 3
- Tapering of NSAIDs should be gradual (e.g., aspirin decreased by 250-500 mg every 1-2 weeks, ibuprofen decreased by 200-400 mg every 1-2 weeks) 1, 3
Monitoring Treatment Response
- Serum CRP should be used to guide treatment length and assess response to therapy 1, 4
- Anti-inflammatory therapy should be continued until complete symptom resolution and CRP normalization 2, 4
- Tapering of colchicine is not mandatory but may be considered in the last weeks of treatment to prevent persistence of symptoms and recurrence 1, 3
Activity Restrictions During Treatment
- Exercise restriction is recommended until symptoms resolve and diagnostic tests (CRP, ECG, and echocardiogram) normalize 1, 2
- For athletes, a minimum restriction period of 3 months from the initial onset is recommended 1
- For non-athletes, activity restriction may be shorter, lasting only until symptom remission 1
Special Considerations
- Corticosteroids should only be considered as second-line therapy when there are contraindications to or failure of aspirin/NSAIDs and colchicine, and when infectious causes have been excluded 1, 4
- If corticosteroids are necessary, low to moderate doses (prednisone 0.2-0.5 mg/kg/day) are preferred over high doses 1, 3
- The risk of recurrence is 15-30% after the initial episode without colchicine treatment, increasing to 50% after the first recurrence 2, 3
Management of Specific Types of Pericarditis
- For bacterial pericarditis, urgent pericardial drainage combined with appropriate intravenous antibacterial therapy is mandatory 5
- In purulent pericarditis, open surgical drainage is generally preferred over catheter drainage 5
- For tuberculous pericarditis, specific antituberculous therapy is required for several months 5
Pitfalls to Avoid
- Inadequate treatment duration is a common cause of recurrence 3
- Premature discontinuation of colchicine before the recommended 3-month period increases risk of recurrence 2, 3
- Using corticosteroids as first-line therapy can promote chronicity and increase risk of recurrence 1, 3
- Failure to monitor CRP levels to guide treatment duration may lead to premature discontinuation of therapy 1, 4