Interventions for Tuberculosis Control and Elimination 2002

In an uncontrolled study in Zambia, HIV-infected patients treated for
tuberculosis who had adjunct therapy with corticosteroids developed herpes
zoster and Kaposi’s sarcoma significantly more often, while generalized
lymphadenopathy improved. 924
The routine use of corticosteroids as adjunct therapy for pulmonary
tuberculosis cannot, therefore, be recommended. In addition to the multitude
of known adverse effects directly related to steroid use, in tropical
countries parasitic infestation is common and corticosteroids in such patients
may precipitate dissemination 925 and abscesses. 926
The indication for the use of corticosteroids in pulmonary tuberculosis
should be restricted to patients so seriously ill that their prognosis is judged
to be very poor and thus the steroids are potentially life-saving. 7,927
Extrapulmonary tuberculosis
Tuberculosis of serous membranes
Pleural tuberculosis
A number of studies have been reported evaluating the use of corticosteroids
in pleural tuberculosis. 928-937 Not all of the studies were conducted
with the same rigor and only eight provide sufficient information for an
adequate evaluation. 928-933,936,937
Most studies showed a more rapid resolution of effusions in those
given corticosteroids. In the studies that evaluated residual pleural thickening
as the crucial endpoint, three found less thickening in the steroid
treated group 930-932 and two found no difference between placebo and steroid
treated groups. 936,937
From these studies it would appear that the value of corticosteroids in
the treatment of pleural effusion is doubtful. Weighted against the possible
adverse effects, steroids should probably not be routinely used in tuberculous
pleural effusion.
Pericardial tuberculosis
The efficacy of corticosteroid therapy for tuberculous pericarditis may differ
for the different physiological stages of the disease (effusive, effusiveconstrictive,
and constrictive). 908 Several retrospective studies fail to address
these points and lack well-defined endpoints. 938,939 In a retrospective study
addressing the critical issue of stage of disease, patients on corticosteroids
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