Randomized controlled trial of dexamethasone in tuberculous meningitis

Kumarvelu, S.; Prasad, Kameshwar; Khosla, Ankaj; Behari, Madhuri; Gk, Ahuja

doi:10.1016/0962-8479(94)90009-4

Cited by 66 publications

(48 citation statements)

References 13 publications

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“…Three trials included rifampin. 111,113,116 In all studies, treatment with corticosteroids reduced the mortality rate, and in 4 the differences were significant. [111][112][113][114][115] In the largest, overall mortality fell from 41% to 32%.…”

Section: Tuberculous Meningitismentioning

confidence: 93%

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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Section: Tuberculous Meningitismentioning

confidence: 93%

Use of Corticosteroids in Treating Infectious Diseases

McGee¹

2008

Arch Intern Med

109

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“…These data represent the lower limit of our experience because possible cases were not used in these calculations. The current incidence of tu¬ berculosis for Houston is 750 per year (24 per 100 000), 13(42) 7 (35) 6(55) 3 (10) 1 (5) 2 (18) 4 (13) 2 (10) 2 (18) 2(6) 1 (5) 1 (9) 2(6) 1 (5) 1 (9) 10(32) 8 (40) 2 (18) Because the studied population includes 20 patients with AIDS and because HIV infection is a well- Accepted for publication March 19, 1996. Presented as a poster at the annual Baylor College of Medicine house staff symposium, Houston, Tex, April 6,1995, and at the 31st annual meeting of the Infectious Disease Society ofAmerica, New Orleans, La, October 16, …”

mentioning

confidence: 99%

Tuberculous meningitis among adults with and without HIV infection. Experience in an urban public hospital

Yechoor¹

1996

Archives of Internal Medicine

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“…No trial demonstrated significantly worse outcomes with the use of adjunctive corticosteroids in patients with TBM. In fact, most data suggested earlier clinical improvement [35,42], fewer neurologic sequelae [35,[40][41][42]44], and/or improved survival [36,39,41,44,46].…”

Section: Adjunctive Therapiesmentioning

confidence: 99%

“…By far, most studies have evaluated the use of corticosteroids, because persistent CNS inflammation despite antimicrobial therapy is believed to be responsible for much of the increased morbidity and mortality observed in patients with TBM [1]. To date, 12 controlled trials have examined the role of adjunctive corticosteroids in the treatment of TBM (Table 2) [35][36][37][38][39][40][41][42][43][44][45][46]. These trials differ in the severity of illness of the patients studied, patient age, outcomes analyzed, and the dose, form, and duration of corticosteroid therapy.…”

Section: Adjunctive Therapiesmentioning

confidence: 99%

Approach to the Diagnosis and Management of Tuberculous Meningitis

Sinner¹

2010

Curr Infect Dis Rep

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Meningitis caused by Mycobacterium tuberculosis remains an important cause of morbidity and mortality worldwide, and presents particular challenges in terms of diagnosis and management. The nonspecific clinical presentation of tuberculous meningitis (TBM) has led researchers to develop newer molecular methods of making the diagnosis. Several of these methods have excellent sensitivity and specificity, although many are not yet available for clinical use. Successful treatment of TBM requires a combination of antimicrobial agents, with vigilance regarding the possibility of disease caused by resistant organisms. Adjunctive corticosteroids also have a role in treating this potentially devastating infection, as can neurosurgery. With proper therapy, morbidity and mortality can be minimized in patients with TBM.

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Randomized controlled trial of dexamethasone in tuberculous meningitis

Cited by 66 publications

References 13 publications

Use of Corticosteroids in Treating Infectious Diseases

Use of Corticosteroids in Treating Infectious Diseases

Tuberculous meningitis among adults with and without HIV infection. Experience in an urban public hospital

Approach to the Diagnosis and Management of Tuberculous Meningitis

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