# Purulent Pericarditis: Treating a Medically-Complex Patient With Intrapericardial Antibiotics

## TL;DR

This case report describes a treatment protocol using intrapericardial antibiotics for a rare and severe heart infection in a 51-year-old man.

## Contribution

A novel treatment approach using intrapericardial vancomycin without fibrinolytics for MSSA purulent pericarditis in an adult.

## Key findings

- Intrapericardial vancomycin infusions improved purulent output in a medically complex patient.
- The treatment was safely administered without causing significant complications.
- Combining intravenous and intrapericardial antibiotics was effective for MSSA pericarditis.

## Abstract

Purulent pericarditis is a rare, lethal complication of a bacterial pericardial infection. This case report outlines the protocol for instilling intrapericardial antibiotics for methicillin-sensitive Staphylococcus aureus (MSSA) pericarditis without fibrinolytics in a 51-year-old man.

An appropriately sized percutaneous pericardial drain was placed. Then, a 3-day course of intrapericardial infusions of 50 mL vancomycin was begun. Drainage of all accessible fluid was performed before each infusion. The daily infusions each had an 8-hour dwell time. The prior drainage protocol continued after each infusion.

Strict dosage and infusion length management are required to prevent direct toxicity. Potential complications include local inflammatory responses and constrictive pericarditis.

The use of simultaneous intravenous and intrapericardial antibiotics were used for treating MSSA purulent pericarditis without using intrapericardial fibrinolytics in an adult. This was noted to favorably improve the purulent output and relative safety without untoward complications.