Dexamethasone in Tuberculous Meningitis

O'toole, Richard D.; Thornton, George F.; Mukherjee, Mrinal K.; Nath, Ruponti

doi:10.7326/0003-4819-70-1-39

Cited by 108 publications

(19 citation statements)

References 22 publications

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“…The included trials were conducted in different time periods (one in the 1960s, one in the 1980s, four in the 1990s, and two between 2001 and 2007) and in different geographical regions: Thailand (Chotmongkol 1996); Egypt (Girgis 1991); India (O'Toole 1969; Kumarvelu 1994; Prasad 2006; Malhotra 2009); Philippines (Lardizabal 1998); South Africa (Schoeman 1997); and Vietnam (Thwaites 2004). …”

Section: Resultsmentioning

confidence: 99%

“…The trials included young children (Schoeman 1997) or adults (Kumarvelu 1994; Chotmongkol 1996; Lardizabal 1998; Thwaites 2004; Prasad 2006), or both (O'Toole 1969; Girgis 1991), and both sexes. All trials used the British Medical Research Council (MRC) system, MRC 1948, to assess baseline severity; two trials included only participants with stage II and III tuberculous meningitis (Schoeman 1997; Lardizabal 1998), while the other trials included participants with all stages of severity.…”

Section: Resultsmentioning

confidence: 99%

“…All but one trial reported on disabling neurological deficit in some way, although there was substantial variation in methods of assessment of this outcome between the trials (O'Toole 1969). We accepted the trial authors' definition of disability and, for the purpose of analysis, classified residual deficits into disabling or non-disabling (as shown in Table 4).…”

Section: Resultsmentioning

confidence: 99%

“…We assessed four trials (O'Toole 1969; Chotmongkol 1996; Thwaites 2004; Prasad 2006) as having adequate allocation concealment, with participants allocated coded treatment packs. The remaining trials did not clearly describe allocation concealment.…”

Section: Resultsmentioning

confidence: 99%

“…Four included trials had adequate blinding of participants and personnel (O'Toole 1969; Chotmongkol 1996; Thwaites 2004; Prasad 2006). Participants and personnel were not blinded in the remaining trials.…”

Section: Resultsmentioning

confidence: 99%

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Corticosteroids for managing tuberculous meningitis

Prasad

Singh

Ryan

2016

Cochrane Database of Systematic Reviews

296

153

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Background Tuberculous meningitis is a serious form of tuberculosis (TB) that affects the meninges that cover a person's brain and spinal cord. It is associated with high death rates and with disability in people who survive. Corticosteroids have been used as an adjunct to antituberculous drugs to treat people with tuberculous meningitis, but their role has been controversial. Objectives To evaluate the effects of corticosteroids as an adjunct to antituberculous treatment on death and severe disability in people with tuberculous meningitis. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register up to the 18 March 2016; CENTRAL; MEDLINE; EMBASE; LILACS; and Current Controlled Trials. We also contacted researchers and organizations working in the field, and checked reference lists. Selection criteria Randomized controlled trials that compared corticosteroid plus antituberculous treatment with antituberculous treatment alone in people with clinically diagnosed tuberculous meningitis and included death or disability as outcome measures. Data collection and analysis We independently assessed search results and methodological quality, and extracted data from the included trials. We analysed the data using risk ratios (RR) with 95% confidence intervals (CIs) and used a fixed‐effect model. We performed an intention‐to‐treat analysis, where we included all participants randomized to treatment in the denominator. This analysis assumes that all participants who were lost to follow‐up have good outcomes. We carried out a sensitivity analysis to explore the impact of the missing data. Main results Nine trials that included 1337 participants (with 469 deaths) met the inclusion criteria. At follow‐up from three to 18 months, steroids reduce deaths by almost one quarter (RR 0.75, 95% CI 0.65 to 0.87; nine trials, 1337 participants, high quality evidence ). Disabling neurological deficit is not common in survivors, and steroids may have little or no effect on this outcome (RR 0.92, 95% CI 0.71 to 1.20; eight trials, 1314 participants, low quality evidence ). There was no difference between groups in the incidence of adverse events, which included gastrointestinal bleeding, invasive bacterial infections, hyperglycaemia, and liver dysfunction. One trial followed up participants for five years. The effect on death was no longer apparent at this time‐point (RR 0.93, 95% CI 0.78 to 1.12; one trial, 545 participants, moderate quality evidence); and there was no difference in disabling neurological deficit detected (RR 0.91, 95% CI 0.49 to 1.69; one trial, 545 participants, low quality evidence ). One trial included human immunodeficiency virus (HIV)‐positive people. The stratified a...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Corticosteroids for managing tuberculous meningitis

Prasad

Singh

Ryan

2016

Cochrane Database of Systematic Reviews

296

153

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Tuberculous meningitis in an urban general hospital

Haas¹,

Madhavan²,

Quinn³

et al. 1977

Archives of Internal Medicine

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Use of Corticosteroids in Treating Infectious Diseases

McGee¹

2008

Arch Intern Med

109

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linicians have generally avoided prescribing corticosteroids for active infection because of their known immunosuppressive effects and concern about long-term complications. We conducted a review of the published randomized, double-blind trials comparing corticosteroids and placebo in infections. Except in some trials of viral infections, sore throat, and cerebral cysticercosis, all patients also received active antimicrobial agents in addition to placebo or corticosteroids. For patients with bacterial meningitis, tuberculous meningitis, tuberculous pericarditis, severe typhoid fever, tetanus, or pneumocystis pneumonia with moderate to severe hypoxemia, treatment with corticosteroids improved patient survival (group 1 infections). For patients with bacterial arthritis, corticosteroids were also beneficial and reduced long-term disability (group 2 infections). For about a dozen other infections, corticosteroids significantly relieved symptoms (group 3 infections), and clinicians should consider using them if symptoms are substantial. Corticosteroids were harmful in 2 infections, viral hepatitis and cerebral malaria (group 5 infections). We conclude that corticosteroids are beneficial and safe for a wide variety of infections, although courses longer than 3 weeks should be withheld from patients with concomitant human immunodeficiency virus infection and low CD4 counts.

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Dexamethasone in Tuberculous Meningitis

Cited by 108 publications

References 22 publications

Corticosteroids for managing tuberculous meningitis

Corticosteroids for managing tuberculous meningitis

Tuberculous meningitis in an urban general hospital

Use of Corticosteroids in Treating Infectious Diseases

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