tailieunhanh - Role of Corticosteroids in the Treatment of Tuberculosis: An Evidence-based Update

Corticosteroids are often used as an adjunct in the treatment of various forms of tuberculosis (TB) and for the prevention of complications, such as constrictive pericarditis, hydrocephalus, focal neurological deficits, pleural adhesions, and intestinal strictures. Notwithstanding, they have been proven in clinical trials to improve the following outcomes only — death or disability in human immunodeficiency virus (HIV)-seronegative patients with tubercular meningitis and tubercular pericarditis. Despite a lack of specific evidence for efficacy in HIV co-infected patients with tubercular meningitis or pericarditis, corticosteroids are generally recommended in them as well. Corticosteroids significantly decrease the risk of pleural thickening in patients with tubercular pleural effusion; the clinical. | Review Article Role of Corticosteroids in the Treatment of Tuberculosis An Evidence-based Update Tamilarasu Kadhiravan and Surendran Deepanjali Department of Medicine Jawaharlal Institute of Postgraduate Medical Education and Research Puducherry India ABSTRACT Corticosteroids are often used as an adjunct in the treatment of various forms of tuberculosis TB and for the prevention of complications such as constrictive pericarditis hydrocephalus focal neurological deficits pleural adhesions and intestinal strictures. Notwithstanding they have been proven in clinical trials to improve the following outcomes only death or disability in human immunodeficiency virus HIV -seronegative patients with tubercular meningitis and tubercular pericarditis. Despite a lack of specific evidence for efficacy in HIV co-infected patients with tubercular meningitis or pericarditis corticosteroids are generally recommended in them as well. Corticosteroids significantly decrease the risk of pleural thickening in patients with tubercular pleural effusion the clinical significance of this finding however is unclear. Recently it has been demonstrated that use of corticosteroids improve the morbidity in HIV co-infected patients with paradoxical TB immune reconstitution inflammatory syndrome IRIS . However evidence favouring the use of corticosteroids in other clinical situations is sparse or lacking. Likewise the biological mechanisms underlying their beneficial effect in TB meningitis and pericarditis remain poorly understood. Indian J Chest Dis Allied Sci 2010 52 153-158 Key words Glucocorticoids HIV infection Immune reconstitution inflammatory syndrome Treatment outcome Tuberculosis INTRODUCTION Corticosteroids specifically glucocorticoids have been used as an adjunct in the treatment of various forms of tuberculosis TB for about six decades now. While considerable scepticism exists regarding their efficacy corticosteroids are often over-prescribed in actual practice hoping to prevent the .

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