2A-S3-4

ROLE OF CORTICOSTEROIDS IN THE MANAGEMENT OF TUBERCULOSIS

Yew WW

Grantham Hospital, Aberdeen, Hong Kong, CHINA

 

Recommendations on the use of systemic corticosteroids as adjunctive management of both extra-pulmonary and pulmonary tuberculosis have emerged from progressive accumulation of clinical data.  For the former, the strongest evidences are present in tuberculous meningitis and tuberculous pericarditis.  There might also be a place of systemic corticosteroids in the management of some patients with peritoneal, genitourinary and lymph node tuberculosis pending availability of more information, particularly from randomized studies.  For the latter, the signs and symptoms (presumably resulting from hypercytokinaemia) of reactivation tuberculous pneumonia, tuberculous pleuritis, and probably primary tuberculosis (with lymphadenopathy) seem to decrease more rapidly with systemic corticosteroids treatment, though a definite difference in final outcome has not been demonstrated.  Other areas of utility of systemic corticosteroids include tuberculous pyrexia, anti-tuberculosis drug hypersensitivity, and Addison's disease.  Corticosteroids do not appear to attenuate the efficacy of adequate anti-tuberculosis chemotherapy.  Locally administered corticosteroids may merit more thorough evaluation in the future management of selected settings of tuberculosis.