2A-S3-4
ROLE OF CORTICOSTEROIDS IN THE
MANAGEMENT OF TUBERCULOSIS 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.
Yew WW