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- Title
Management of Idiopathic Viral Pericarditis in the Pediatric Population.
- Authors
Schwier, Nicholas C.; Stephens, Katy; Johnson, Peter N.
- Abstract
Idiopathic (viral) pericarditis (IP) is one of the most common etiologies of acute and recurrent pericarditis in children. IP is associated with significant morbidity, and recurrence rates of IP are high and require treatment to decrease risk of recurrence and pericarditis-related chest pain. Despite significant morbidity, sparse guidance exists to comprehensively address management of IP in children. The purpose of this review is to provide an overview of the pharmacotherapy of IP in children, including clinical pearls for managing pediatric patients. Clinicians should consider using the combination of colchicine and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapy, in order to reduce the risk of recurrence and foster symptom improvement in IP. Colchicine dosing may vary depending on patient age, weight, concomitant pharmacotherapies, and disease states. Choice of NSAID should be based on cost, tolerability, and adverse drug events (ADEs). Children should receive higher NSAID attack dosing for >1 week to ensure a reduction in high sensitivity C-reactive protein concentrations and symptom relief. Corticosteroids should be considered last-line for treatment of IP in children, because they increase the risk of recurrence. Immunotherapies may be considered for children with multiple recurrences related to IP despite the use of NSAIDs, colchicine, and/or corticosteroids. Similar to adults, diligent monitoring should be implemented, to prevent drug-drug interactions, drug-disease interactions, and/or ADEs in children. ABBREVIATIONS ADEs, adverse drug events; AKI, acute kidney injury; ASA, aspirin; AUC0-24 hr, area under the curve; CRP, C-reactive protein; CYP, cytochrome; ECG, electrocardiogram; ESC, European Society of Cardiology; FDA, US Food and Drug Administration; FMF, familial Mediterranean fever; GI, gastrointestinal; H2RA, histamine 2 receptor antagonist; HPA, hypothalamic-pituitary-adrenal; hs-CRP, high-sensitivity CRP; IL-1, interleukin 1; IP, idiopathic (viral) pericarditis; IV, intravenous; IVIG, intravenous immunoglobulin; LFTs, liver function tests; NSAIDs, non-steroidal anti-inflammatory drugs; p-gp, p-glycoprotein.
- Subjects
EUROPEAN Society of Cardiology; UNITED States. Food &; Drug Administration; HISTAMINE receptors; C-reactive protein; CHILD patients; ANTIHISTAMINES; H2 receptor antagonists; PERICARDITIS; FAMILIAL Mediterranean fever
- Publication
Journal of Pediatric Pharmacology & Therapeutics, 2022, Vol 27, Issue 7, p595
- ISSN
1551-6776
- Publication type
Article
- DOI
10.5863/1551-6776-27.7.595