Interventions for Tuberculosis Control and Elimination 2002

had a more rapid decrease in pericardial effusion as compared to those not
given corticosteroids. 940
Prospective studies evaluating the use of corticosteroids in the treatment
of tuberculous pericarditis were conducted in the Transkei area of
South Africa. 941-944 These studies showed that fewer patients with acute
effusive pericarditis on corticosteroids required repeated drainage, 941 and
patients with effusive-constrictive pericarditis had faster improvement. 942
In neither study were there differences in constriction, but among patients
with acute effusive pericarditis, corticosteroid recipients had a lower risk
of death. Among HIV-infected patients in Harare, Zimbabwe, corticosteroids
significantly reduced case fatality. 945
From these studies it would seem that adjuvant treatment with corticosteroids
is indicated in patients with pericardial tuberculosis.
Peritoneal tuberculosis
Because of the similarity in the pathogenesis of peritoneal and pericardial
tuberculosis, both involving serous membranes, a beneficial effect of corticosteroid
use in peritoneal tuberculosis similar to that in pericardial tuberculosis
might be expected. 946 Alternatively one may argue that tuberculous
peritonitis is more similar to tuberculous pleurisy. In a retrospective study
from Saudi Arabia, the frequency of recurrent abdominal pain and emergency
department visits were used as endpoints to compare the usefulness
of corticosteroid adjunctive therapy. 947 Corticosteroids appeared to have an
effect in reducing the frequency of these events. However, as the study
was a retrospective evaluation of a case series comparing patients who were
given corticosteroid therapy with patients who had not received corticosteroids,
it is not possible to draw firm conclusions. A prospective trial, allocating
patients to a three-month course with either prednisone or placebo,
was carried out with death and intestinal obstruction evaluated as endpoints.
948 Corticosteroid-treated patients fared better, but the small sample
size did not detect a significant difference in the frequency of these events.
The evidence for the usefulness of corticosteroid treatment as adjunctive
treatment in peritoneal tuberculosis is sufficiently convincing to recommend
its routine use.
Meningeal tuberculosis
Adjunctive treatment with corticosteroids in meningeal tuberculosis has been
widely reported. 949-964 However, not all of the published reports were
prospective, controlled trials.
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