Adjunctive Corticosteroid Therapy for Tuberculosis: A Critical Reappraisal of the Literature

Abstract

An extensive, although largely forgotten, literature addresses the utility of adjunctive corticosteroid therapy in the management of tuberculosis. Corticosteroid therapy probably improves neurological outcomes of, and decreases mortality due to, tuberculous meningitis of moderate severity. Although therapy for tuberculous pericarditis is simplified (with less need for operative intervention) by adjunctive corticosteroid administration and there are fewer deaths, the incidence of subsequent constriction is not changed. The signs and symptoms of typical reactivation tuberculous pneumonia, tuberculous pleurisy, and probably primary tuberculous disease (with lymphadenopathy) seem to decrease rapidly with corticosteroid therapy, although no differences in final outcomes have been observed. Corticosteroid regimens used in most studies varied greatly in duration and dosage and generally caused significant side effects. Corticosteroids do not appear to diminish the efficacy of adequate antimycobacterial therapy. Adjunctive corticosteroid therapy appears to offer significant short-term but (other than for tuberculous meningitis and effusive pericarditis) minimal long-term benefit for patients with tuberculosis.

Neonatal Tuberculosis Associated With Shock, Disseminated Intravascular Coagulation, Hemophagocytic Syndrome, and Hypercalcemia: A Case Report

“…6 There has been no adequate evidence regarding the role of corticosteroid on acute disseminated tuberculosis. 10 Data on corticosteroid use in congenital tuberculosis are very limited.…”

Renal Allograft Tuberculosis: A Case Report

“…8,9 Disseminated TB is common in renal transplant patients, accounting for 40% of cases, 9 in marked contrast to the 0.6%-1.4% incidence in the general population. 18 Disseminated TB in these patients commonly presents as fever of unknown origin.…”

The ERS-endorsed official ATS/CDC/IDSA clinical practice guidelines on treatment of drug-susceptible tuberculosis

“…The role of adjunctive corticosteroid therapy in the treatment of TB meningitis has been investigated by numerous studies [52][53][54][55][56][57][58][59][60][61][62][63][64], and the updated systematic review conducted in support of the guidelines showed a mortality benefit from the use of adjuvant corticosteroids. Therefore, the guidelines recommend adjunctive corticosteroid therapy with dexamethasone or prednisolone tapered over 6-8 weeks for patients with TB meningitis (PICO question 8).…”