Interventions for Tuberculosis Control and Elimination 2002

In none of the nine prospective trials was treatment outcome worse in
the group treated with corticosteroids, as compared to the control group. Survival
in the corticosteroid treated group was improved in four, 957,960,961,964
tended to be better in one, 963 and was not better in four. 955,956,959,964
Fewer sequelae in the corticosteroid-treated group were found in four studies.
959,960,963,964
Studies that looked at the stage of disease and the effects of corticosteroids
found a lack of effect in mild and terminal disease stages (assessed
by the degree of neurologic impairment), but a significant benefit for patients
with intermediate disease stage. 954,957,960 One of these studies 957 determined
that there was no difference in treatment outcome between doses of 1 mg
and 10 mg of dexamethasone. The duration of corticosteroid treatment in
this study was one month.
There is sufficient evidence to recommend the use of corticosteroids
in moderate to severe meningeal and cerebral tuberculosis to improve survival,
although not all patients will benefit from adjunctive corticosteroid
treatment.
Corticosteroid treatment in other forms of tuberculosis
Corticosteroids have been given for other forms of tuberculosis.
In the treatment of endobronchial tuberculosis, adjunctive therapy with
corticosteroids has been shown to be beneficial. 965,966 In children with
bronchial obstruction due to hilar lymphadenopathy, resolution of symptoms
was faster and complications less frequent in corticosteroid-treated
children compared to controls. 967
Patients with peripheral lymphatic tuberculosis are known to frequently
develop new nodes and draining abscesses during chemotherapy which are
bacteriologically sterile and thought to represent an immunologic reaction. 535
It would be desirable to evaluate the potential usefulness of adjunctive corticosteroid
treatment, yet no controlled trial has investigated this issue.
The use of corticosteroids in the treatment of genitourinary tuberculosis
has been reported, 968,969 but the design of the studies was insufficient to
draw conclusion on their efficacy in reducing ureteral strictures.
The role of surgery in the chemotherapy era
Surgery has played a major role in the history of treatment of tuberculosis,
and thoracic surgery was actually largely developed around the treat-
150