**6. Treatment**

In every case of tuberculous pericarditis, hospitalisation of the patient is necessary, as well as initiation of antimycobacterial therapy according to generally accepted protocols. In most patients, a compound scheme of rifampicin, isoniazid, pyrazinamide, and ethambutol administered for at least 2 months, with a continuation of isoniazid and rifampicin treatment for the next 4 months, has been effective (in total, the therapy should last 6 months) [45].

Modifying the treatment is required for patients with comorbid diseases, such as hepatic or renal insufficiency, in which the treatment protocols are chosen according to specific recommendations.

An important complication of tuberculous pericarditis is constrictive pericarditis [1]. Before an effective pharmacotherapy for tuberculosis was implemented, up to 50% of

individuals developed constrictive pericarditis. Treatment protocols based on rifampicin decreased the frequency of this complication to 17–40% [1,7,46]. Steroid administration as an adjuvant therapy lowers the risk of constrictive pericarditis and the necessity for hospitalisation but does not reduce mortality among patients with tuberculous pericarditis [7,28,47–50]. This benefit has been observed both in patients infected with HIV as well as HIV (−) patients [7,28,47–50]. However, the administration of steroids in HIV (+) patients increases the risk of developing secondary malignancies; therefore, adjutant steroid therapy should be implemented with caution in this group of patients [47–50].

Direct intrapericardial administration of fibrinolytic agents may be a potential method of reducing the incidence of constrictive pericarditis in patients with large tuberculous pericardial effusion. However, so far, we do not have any scientific data to support this thesis.
