This handout is for cardiac tamponade — tuberculous pericarditis. Your care team identified this based on: subacute (days-weeks) dyspnea + fever + weight loss + night sweats + beck triad in patient with tb risk factors (endemic region, hiv+, prior tb, healthcare worker) → tuberculous tamponade (esc 2015 §tuberculous pericarditis; mayosi heart 2017).
Other reasons your team may use this plan: echo: pericardial effusion (often large >2 cm) with fibrin strands or septations + rv diastolic collapse + ivc plethora in patient with tb risk factors (esc 2015); hiv+ patient (especially sub-saharan africa, india) presenting with new pericardial effusion — tb pericarditis is leading cause of pericardial disease in this population (mayosi nejm 2014 impi pmid 25199187; sliwa); known pulmonary tb or chest ct with mediastinal lymphadenopathy + cavitary disease + new pericardial effusion (esc 2015; who 2024).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| rifampin | 10 mg/kg PO daily (max 600 mg) | PO | daily × 2 mo intensive + 4 mo continuation | WHO 2024 — first-line anti-TB; CYP450 inducer requiring drug interaction review (especially ART, anticoagulants, contraceptives); orange-colored body fluids |
| isoniazid | 5 mg/kg PO daily (max 300 mg) + pyridoxine 25-50 mg daily | PO | daily × 6 mo total | WHO 2024 — first-line; pyridoxine prevents peripheral neuropathy; hepatotoxicity surveillance |
| pyrazinamide | 25 mg/kg PO daily (max 2000 mg) | PO | daily × 2 mo intensive only | WHO 2024 — intensive phase only; hyperuricemia + hepatotoxicity surveillance; renal dose-adjust |
| ethambutol | 15-25 mg/kg PO daily (max 1600 mg) | PO | daily × 2 mo intensive (continue if drug-resistance) | WHO 2024 — intensive phase; visual acuity + color discrimination monitoring monthly (optic neuritis risk) |
| prednisolone | 60 mg PO daily × 4 wk then taper × 6 wk per IMPI | PO | daily × 4 wk full + 6 wk taper | IMPI trial (Mayosi NEJM 2014 PMID 25199187) — reduced constrictive pericarditis risk in HIV-NEGATIVE; NO mortality benefit; AVOID in HIV+ (increased KS risk in IMPI subgroup) |
| pyridoxine | 25-50 mg PO daily | PO | daily concurrent with INH | Prevents INH-induced peripheral neuropathy; standard with all INH-containing regimens (WHO 2024) |
| normal saline | 500-1000 mL bolus | IV | rapid bolus then reassess | Bridge preload to drainage (ESC 2015) |
| norepinephrine | 0.05-0.1 µg/kg/min titrate to MAP ≥65 | IV | continuous | Bridge only — does not address obstruction (Roy JAMA 2007) |
Plan: Tuberculous pericarditis — pericardiocentesis + 4-drug RIPE × 6 mo + selective adjunctive prednisolone in HIV-NEGATIVE only (ESC 2015; WHO 2024; IMPI Mayosi NEJM 2014 PMID 25199187)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Guideline: 2015 ESC Guidelines for the diagnosis and management of pericardial diseases (Adler EHJ 2015 PMID 26320112) §Tuberculous Pericarditis — remains current as of 2026-05-15. IMPI trial (Mayosi NEJM 2014 PMID 25199187) anchors adjunctive steroid decision (HIV-negative benefit, HIV+ harm); WHO Global TB Report 2024 + WHO TB treatment guidelines 2024 anchor 4-drug RIPE regimen and MDR-TB management; Mayosi Heart 2017 + Sliwa BM tuberculous heart disease in HIV anchor multidisciplinary co-management framework.