Effectiveness of Intrapericardial Administration of Streptokinase in 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.

Zusammenfassung

Bei drei Patienten mit purulenter Perikarditis konnte der Perikarderguss durch chirurgische Perikardiotomie nicht suffizient drainiert werden. Die komplikationslose Sanierung des lokulierten fibrinösen Ergusses gelang nach intraperikardialer Streptokinaseinstillation (50-ml-Lösung mit 500 000 IE Streptokinase, instilliert über 10 min in erster Sitzung, gefolgt von derselben Dosis nach 12 und 24 h). Im weiteren Verlauf ergab sich eine Restitutio ad integrum, ohne dass sich später eine konstriktive Perikarditis entwickelte.