Intrapleural hydrocortisone in tuberculous pleural effusion

Mathur, K. S.; Prasad, Ram; Mathur, Jyoti

doi:10.1016/s0041-3879(60)80038-4

Cited by 19 publications

(3 citation statements)

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“…faster in corticosteroid recipients than in controls (mean duration: 55 days vs. 123 days, respectively; P õ .01). Mathur et al [46] in 1960 used the interesting approach of local instillation of hydrocortisone into involved pleural spaces In summary, several studies have demonstrated beneficial effects of adjunctive steroid use with antituberculous chemo-(in the absence of other systemic steroid therapy). Acute toxicities were markedly reduced in the steroid group than in the therapy for pleural effusions.…”

Section: / 9c3d$$oc26mentioning

confidence: 99%

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

1997

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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.

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Section: / 9c3d$$oc26mentioning

confidence: 99%

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

1997

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“…A number of uncontrolled studies, completed before the use of modern anti-tuberculous chemotherapy, have shown the benefits of steroids used as adjuncts to drugs such as isoniazid, PAS and streptomycin. [24][25][26] Thereafter Grewel et al 27 examined 102 cases of pleural tuberculosis and showed the benefits of adding oral steroids to anti-tuberculous chemotherapy compared with intrapleural administration of steroids and multiple pleurocenteses. Nonetheless, intrapleural steroids showed improved outcomes compared with no steroid treatment at all.…”

Section: Pleural Tuberculosismentioning

confidence: 99%

The use of adjunctive corticosteroids in the treatment of pericardial, pleural and meningeal tuberculosis: Do they improve outcome?

Evans

2008

Respiratory Medicine

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Tuberculosis remains a major cause of mortality and morbidity on a global scale. Effective anti-tuberculous chemotherapy has improved outcomes for individuals suffering from tuberculosis, although the disease often results in significant and permanent damage to organs. The use of adjunctive corticosteroid treatment has been studied with a view to demonstrating a reduction in inflammatory events that may improve outcomes for both mortality and morbidity. Cochrane reviews have summarized the evidence for adjunctive corticosteroids in the treatment of tuberculous pericarditis, meningitis and pleural effusion. These reviews have shown improved mortality for pericarditis and meningitis, but inconclusive effects for pericardial constriction and ongoing neurological disability. Rapid improvements in clinical parameters for pleural effusion were not supported by any lasting improved outcomes for these patients.

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“…One corticosteroid is prednisone, which is converted in the liver into the active drug, prednisolone. Prednisolone is recommended at a daily dose of about 1 mg/kg gradually reducing after one to two weeks, with a total treatment course sometimes being as long as three months (Lemaistre 1951; Mathur 1960; Morehead 1998; Blumberg 2003). …”

Section: Introductionmentioning

confidence: 99%

Corticosteroids for tuberculous pleurisy

Ryan

Yoo

Darsini

2017

Cochrane Database of Systematic Reviews

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Background Corticosteroids used in addition to antituberculous therapy have been reported to benefit people with tuberculous pleurisy. However, research findings are inconsistent and raise doubt as to whether such treatment is worthwhile. There is also concern regarding the potential adverse effects of corticosteroids, especially in HIV‐positive people. Objectives To evaluate the effects of adding corticosteroids to drug regimens for tuberculous pleural effusion. Search methods In April 2016, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (the Cochrane Library), MEDLINE, Embase, LILACS, Current Controlled Trials, and the reference lists of articles identified by the literature search. Selection criteria Randomized controlled trials (RCTs) and quasi‐RCTs that compared any corticosteroid with no treatment, placebo, or other active treatment (both groups should have received the same antituberculous drug regimen) in people diagnosed with tuberculous pleurisy. Data collection and analysis Two review authors independently screened the search results, extracted data from the included trials, and assessed trial methodological quality using the Cochrane 'Risk of bias' tool. We analysed the data using risk ratios (RR) with 95% confidence intervals (CIs). We applied the fixed‐effect model in the absence of statistically significant heterogeneity. Main results Six trials with 590 participants met the inclusion criteria, which were conducted in Asia (three trials), Africa (two trials), and Europe (one trial). Two trials were in HIV‐negative people, one trial was in HIV‐positive people, and three trials did not report HIV status. Corticosteroids may reduce the time to resolution of pleural effusion. Risk of residual pleural effusion on chest X‐ray was reduced by 45% at eight weeks (RR 0.54, 95% CI 0.37 to 0.78; 237 participants, 2 trials, low certainty evidence ), and 65% at 24 weeks (RR 0.35, 95% CI 0.18 to 0.66; 237 participants, 2 trials, low certainty evidence ). Compared with control, corticosteroids may reduce the risk of having pleural changes (such as pleural thickening or pleural adhesions), on chest X‐ray at the end of follow‐up by almost one third (RR 0.72, 95% CI 0.57 to 0.92; 393 participants, 5 trials, low certainty evidence ), which translates to an absolute risk reduction of 16%. One trial reported deaths in people that were HIV‐positive, with no obvious difference between the groups; the trial authors' analysis suggests that the deaths observed in this trial were related to HIV disease rather than pleural TB (RR 0.91, 95% CI 0.64 to 1.31; 197 participants, 1 trial). We found limited data on long‐term functional respiratory impairment on 187 people in two trials, which...

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Intrapleural hydrocortisone in tuberculous pleural effusion

Cited by 19 publications

References 3 publications

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

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

The use of adjunctive corticosteroids in the treatment of pericardial, pleural and meningeal tuberculosis: Do they improve outcome?

Corticosteroids for tuberculous pleurisy

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