Management of Idiopathic Viral Pericarditis in the Pediatric Population

J Pediatr Pharmacol Ther. 2022;27(7):595-608. doi: 10.5863/1551-6776-27.7.595. Epub 2022 Sep 26.


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.

Keywords: colchicine; corticosteroids; ibuprofen; idiopathic; pediatrics; pericarditis; viral.

Grant support

Disclosures. Dr Schwier is a paid consultant and serves on the advisory board of Kiniksa Pharmaceuticals. No financial incentive was provided to Dr Schwier in the preparation of this manuscript. Kiniksa Pharmaceuticals was not involved in the preparation of this manuscript.