Treatment of Tuberculous Pleural Effusion with Local Instillation of Hydrocortisone

The Efficacy and Safety of Adjunctive Corticosteroids in the Treatment of Tuberculous Pleurisy: A Systematic Review and Meta‐analysis

“…The systematic literature search identified 802 studies on corticosteroids, of which 17 trials comprised patients with tuberculous pleurisy. After excluding 7 studies, 10 trials were included in this analysis that involved 957 tuberculous pleurisy patients [8][9][10][18][19][20][21][22][23][24]. Figure 1 and Supplementary File 1 show the reasons for the exclusion of various studies.…”

“…Ten studies on corticosteroid use (six randomized studies and four cohort studies) between 1958 and 2006 were included in the study (Table 1) and comprised 957 patients [8][9][10][18][19][20][21][22][23][24]. Of these 10 studies, two were conducted in South Korea [18,21], and two in India [8,24]; the others were conducted in Uganda [19], South Africa [22], Taiwan [20], England [23], and Iraq [10]. Nine trials comprised both men and women; 62% (men, from 47 to 97%).…”

“…The follow-up period ranged from 6.0 months [22] to 46 months [9]. Nine studies included prednisone or placebos as an adjunct to the anti-TB regimen, including INH (isoniazid), RM (rifampin), PZA (pyrazinamide), EMB (ethambutol), SM (streptomycin) (except in Mansour, which did not state them in detail) [8,9,[18][19][20][21][22][23][24]. Corticosteroids were given orally in various doses (0.75-1.0 mg/kg/day) [8-10, 19, 20, 22, 23].…”

“…Corticosteroids were given orally in various doses (0.75-1.0 mg/kg/day) [8-10, 19, 20, 22, 23]. The patients in the Bang and Lee [18,21] studies were injected with 1.0 mg/kg/d and 30 mg/d corticosteroids, and the patients in Mansour et al [24] were treated with 125-250 mg intrapleural hydrocortisone.…”

“…The outcomes comprised pleural effusion reabsorption (six studies reported the outcome at 4.0 weeks [8,9,[18][19][20]24] and six studies reported the outcome at 8.0 weeks, [8,[18][19][20][21]), the presence of pleural thickening (seven trials), [8-10, 20-22, 24] and adhesions (two trials) [18,20] number of days to achieve improved symptoms and signs (three trials), [10,18,20], 7-d relief of clinical symptoms (two trials), [20,24] death from any cause (one trial), [19] and adverse effects (seven trials). [9,[18][19][20][21][22]24]…”