Corticosteroids and tuberculosis

doi:10.1016/S0954-6111(05)80002-2

Respiratory Medicine

Volume 88, Issue 8, September 1994, Pages 561-565

https://doi.org/10.1016/S0954-6111(05)80002-2 Get rights and content

Summary

Common for all older studies is the use of less potent anti-tuberculosis chemotherapy as compared with the present. The results of these studies cannot without reservation be used in the present setting.

The newer, prospective, randomized placebocontrolled trials include rather few patients and their number is limited. The results must be interpreted carefully.

There is no reason to give prophylactic isoniazide treatment to Mantoux-positive patients or patients with earlier tuberculosis who start treatment with corticosteroids.

If allergic reactions to one of the antituberculous drugs emerge during therapy, the treatment can, if necessary, be continued if corticosteroids are added.

Pericardial tuberculosis and atelectasis in children with endobronchial tuberculosis should be treated with corticosteroids, as can pleural disease with prolonged fever and exudation.

Cases of severe pulmonary tuberculosis may be treated with supplementary steroids. The effect seems modest.

Patients with tuberculous meningitis, stages II and III seem to benefit from corticosteroid-treatment.

References (38)

AspinJ et al.
Steroid-treated tuberculous pleural effusions
Br J Tub Dis Chest
(1958)
MathurKS et al.
Intrapleural hydrocortisone in tuberculous pleural effusion
Tubercle
(1960)
MenonNK
Steroid therapy in tuberculous pleural effusion
Tubercle
(1964)
LeeC-H et al.
Corticosteroids in the treatment of tuberculous pleurisy
Chest
(1988)
StrangJIG et al.
Controlled trial of prednisolone as adjuvant in treatment of tuberculous constrictive pericarditis in Transkei
Lancet
(1987)
AllenMB et al.
Corticosteroids and tuberculosis
BMJ
(1991)
SmyllieHC et al.
Incidence of serious complications of corticosteroid therapy in respiratory disease
Thorax
(1968)
SchatzM et al.
The prevalence of tuberculosis and positive tuberculin skin tests in a steroid-treated asthmatic population
Ann Intern Med
(1976)
CowieRL et al.
Pulmonary tuberculosis in corticosteroid-treated asthmatics
S Afr Med J
(1987)
Powell-JacksonPR et al.
Am Rev Respir Dis
(1983)

Tuberculosis in corticosteroid-treated asthmatics

BMJ

(1976)

American Thoracic Society

Treatment of tuberculosis and tuberculous infection in adults and children

Am Rev Respir Dis

(1986)

ThomsonJE

The management of hypersensitivity reactions to antituberculous drugs

Med J Aust

(1969)

HoughtonLE

Combined corticotropin therapy and chemotherapy in pulmonary tuberculosis

Lancet

(1954)

JohnsonJR et al.

Corticosteroids in pulmonary tuberculosis

Am Rev Respir Dis

(1967)

HorneNW

Prednisolone in treatment of pulmonary tuberculosis: A controlled trial

BMJ

(1960)

PaleySS et al.

Prednisone in the treatment of tuberculous pleural effusions

Am Rev Tuberc Pulm Dis

(1959)

TaniP et al.

Cortisone therapy for exudative tuberculous pleurisy in the light of a follow-up study

Acta Tuberc Pneum Scand

(1964)

GrewalKS et al.

A comparative study of therapeutic regimens with and without corticosteroids in the treatment of tuberculous pleural effusion

J Ind Med Ass

(1969)

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Corticosteroids and tuberculosis

Summary

Br J Tub Dis Chest

Tubercle

Tubercle

Chest

Lancet