Could Corticosteroids Be Used for Pulmonary Tuberculosis Combined with Tuberculous Meningitis and Tuberculous Pericarditis: An Evidence-based Treatment for a 14-year-old Boy_Chinese Journal of Evidence-Based Medicine

Authors：

TAN Jianlong , WANG Shuang , LIAO Zaibo

Department of Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Tuberculous meningitis; Tuberculous pericarditis; Pulmonary tuberculosis; Corticosteroids; Evidencebased treatment

DOI：

10.7507/1672-2531.20080242

Video：

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Objective 　To formulate an evidence-based treatment for a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis.
Methods 　According to the principles of evidencebased clinical practice, we searched The Cochrane Library (Issue 2, 2008), Ovid-Reviews (1991 to 2008), MEDLINE (1950 to 2008), and http://www.guideline.org. to identify the best evidence for treating a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis.
Results 　Nine guidelines, 2 systematic reviews, and 11 randomized controlled trials were included. The evidence showed that corticosteroids could help reduce the risk of death and disabling residual neurological deficiencies in patients with tuberculous meningitis. After adjusting for age and gender, the overall death rate of patients with tuberculous pericarditis was significantly reduced by prednisolone (P=0.044), as well as the risk of death from pericarditis (P=0.004). But for patients with pulmonary tuberculosis, there was still a controversy about the use of corticosteroids. Given the evidence, the patient’s clinical conditions, and his preferences, dexamethasone was used for the boy in question. After 7 weeks of treatment, his cerebrospinal fluid returned to normal and pericardial effusion disappeared.
Conclusion 　 Corticosteroids should be recommended in HIV-negative people with tuberculous meningitis or/and tuberculous pericarditis. The difference in the effectiveness of various corticosteroids such as dexamethasone, prednisolone, or methylprednisolone and the optimal duration of corticosteroid therapy is still unknown.

Citation： TAN Jianlong,WANG Shuang,LIAO Zaibo. Could Corticosteroids Be Used for Pulmonary Tuberculosis Combined with Tuberculous Meningitis and Tuberculous Pericarditis: An Evidence-based Treatment for a 14-year-old Boy. Chinese Journal of Evidence-Based Medicine, 2008, 08(12): 1122-1125. doi: 10.7507/1672-2531.20080242 Copy

1.	Kumarvelu S, Prasad K, Khosla A, et al. Randomized controlled trial of dexamethasone in tuberculous meningitis. Tuber Lung Dis, 1994, 75(3): 203-207.
2.	Toppet M, Malfroot A, Derde MP, et al. Corticosteroids in primary tuberculosis with bronchial obstruction. Arch Dis Child, 1990, 65(11): 1222-1226.
3.	Park IW, Choi BW, Hue SH. Prospective study of corticosteroid as an adjunct in the treatment of endobronchial tuberculosis in adults. Respirology, 1997, 2(4): 275-281.
4.	Anonymous. Study of chemotherapy regimens of 5 and 7 months’ duration and the role of corticosteroids in the treatment of sputumpositive patients with pulmonary tuberculosis in South India. Tubercle, 1983, 64(2): 73-91.
5.	Bilaceroglu S, Perim K, Buyuksirin M, et al. Prednisolone: a beneficial and safe adjunct to antituberculosis treatment? A random-ized controlled trial. Int J Tuberc Lung Dis, 1999, 3(1): 47-54.
6.	Strang JIG, Kakaza HHS, Gibson DG, et al. Controlled trial of prednisolone as adjuvant in treatment of tuberculous constrictive pericarditis in Transkei. Lancet, 1987, 2(8573): 1418-1422.
7.	Strang JIG, Kakaza HHS, Gibson DG, et al. Controlled clinical trial of complete open surgical drainage and of prednisolone in treatment of tuberculous pericardial effusion in Transkei. Lancet, 1988, 2(8614): 759-764.
8.	Mayosi BM, Ntsekhe M, Volmink JA, et al. Interventions for treating tuberculous pericarditis. Cochrane Database of Systematic Reviews 2002, Issue 4.
9.	Hakim J, Ternouth I, Mushangi E, et al. A. Double blind randomised placebo controlled trial of adjuvant prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients. Heart, 2000, 84: 183-188.
10.	Strang JI, Nunn AJ, Johnson DA, et al. Management of tuberculous constrictive pericarditis and tuberculous pericardial effusion in Transkei: results at 10 years follow-up. QJM, 2004 , 97(8): 525-535.
11.	Girgis NI, Farid Z, Kilpatrick ME, et al. Dexamethasone adjunctive treatment for tuberculous meningitis. Pediatr Infect Dis J, 1991, 10(3): 179-183.
12.	Thwaites GE, Nguyen DB, Nguyen HD, et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med, 2004, 351(17): 1741-1751.
13.	O’Toole RD, Thornton GF, Mukherjee MK, et al. Dexamethasone in tuberculous meningitis. Relationship of cerebrospinal fluid effects to therapeutic efficacy. Ann Intern Med, 1969, 70(1): 39-47.
14.	Schoeman JF, Van Zyl LE, Laubscher JA, et al. Effect of corticosteroids on intracranial pressure, computed tomographic findings, and clinical outcome in young children with tuberculous meningitis. Pediatrics, 1997, 99(2): 226-231.
15.	Kumarvelu 1994 [published and unpublished data] Kumarvelu S, Prasad K, KhoslaA, et al. Randomized controlled trial of dexamethasone in tuberculous meningitis. Tuber Lung Dis, 1994, 75(3): 203-207.
16.	Prasad K, SinghMB. Corticosteroids for managing tuberculous meningitis. Cochrane Database of Systematic Reviews 2008, Issue 1. Art.
17.	Centers for Disease Control and Prevention. Treatment of Tuberculosis, American Thoracic Society, CDC, and Infectious Diseases Society of America. MMWR 2003; 52 (No. RR-11): [inclusive page numbers].
18.	National Collaborating Centre for Chronic Conditions. Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. London (UK): Royal College of Physicians; 2006. 215.

1. Kumarvelu S, Prasad K, Khosla A, et al. Randomized controlled trial of dexamethasone in tuberculous meningitis. Tuber Lung Dis, 1994, 75(3): 203-207.
2. Toppet M, Malfroot A, Derde MP, et al. Corticosteroids in primary tuberculosis with bronchial obstruction. Arch Dis Child, 1990, 65(11): 1222-1226.
3. Park IW, Choi BW, Hue SH. Prospective study of corticosteroid as an adjunct in the treatment of endobronchial tuberculosis in adults. Respirology, 1997, 2(4): 275-281.
4. Anonymous. Study of chemotherapy regimens of 5 and 7 months’ duration and the role of corticosteroids in the treatment of sputumpositive patients with pulmonary tuberculosis in South India. Tubercle, 1983, 64(2): 73-91.
5. Bilaceroglu S, Perim K, Buyuksirin M, et al. Prednisolone: a beneficial and safe adjunct to antituberculosis treatment? A random-ized controlled trial. Int J Tuberc Lung Dis, 1999, 3(1): 47-54.
6. Strang JIG, Kakaza HHS, Gibson DG, et al. Controlled trial of prednisolone as adjuvant in treatment of tuberculous constrictive pericarditis in Transkei. Lancet, 1987, 2(8573): 1418-1422.
7. Strang JIG, Kakaza HHS, Gibson DG, et al. Controlled clinical trial of complete open surgical drainage and of prednisolone in treatment of tuberculous pericardial effusion in Transkei. Lancet, 1988, 2(8614): 759-764.
8. Mayosi BM, Ntsekhe M, Volmink JA, et al. Interventions for treating tuberculous pericarditis. Cochrane Database of Systematic Reviews 2002, Issue 4.
9. Hakim J, Ternouth I, Mushangi E, et al. A. Double blind randomised placebo controlled trial of adjuvant prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients. Heart, 2000, 84: 183-188.
10. Strang JI, Nunn AJ, Johnson DA, et al. Management of tuberculous constrictive pericarditis and tuberculous pericardial effusion in Transkei: results at 10 years follow-up. QJM, 2004 , 97(8): 525-535.
11. Girgis NI, Farid Z, Kilpatrick ME, et al. Dexamethasone adjunctive treatment for tuberculous meningitis. Pediatr Infect Dis J, 1991, 10(3): 179-183.
12. Thwaites GE, Nguyen DB, Nguyen HD, et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med, 2004, 351(17): 1741-1751.
13. O’Toole RD, Thornton GF, Mukherjee MK, et al. Dexamethasone in tuberculous meningitis. Relationship of cerebrospinal fluid effects to therapeutic efficacy. Ann Intern Med, 1969, 70(1): 39-47.
14. Schoeman JF, Van Zyl LE, Laubscher JA, et al. Effect of corticosteroids on intracranial pressure, computed tomographic findings, and clinical outcome in young children with tuberculous meningitis. Pediatrics, 1997, 99(2): 226-231.
15. Kumarvelu 1994 [published and unpublished data] Kumarvelu S, Prasad K, KhoslaA, et al. Randomized controlled trial of dexamethasone in tuberculous meningitis. Tuber Lung Dis, 1994, 75(3): 203-207.
16. Prasad K, SinghMB. Corticosteroids for managing tuberculous meningitis. Cochrane Database of Systematic Reviews 2008, Issue 1. Art.
17. Centers for Disease Control and Prevention. Treatment of Tuberculosis, American Thoracic Society, CDC, and Infectious Diseases Society of America. MMWR 2003; 52 (No. RR-11): [inclusive page numbers].
18. National Collaborating Centre for Chronic Conditions. Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. London (UK): Royal College of Physicians; 2006. 215.

Chinese Journal of Evidence-Based Medicine

Could Corticosteroids Be Used for Pulmonary Tuberculosis Combined with Tuberculous Meningitis and Tuberculous Pericarditis: An Evidence-based Treatment for a 14-year-old Boy

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