A systematic review of the adjunctive use of systemic corticosteroids for pulmonary tuberculosis.

OBJECTIVE To determine the safety and benefit of adjunctive systemic corticosteroid therapy in the management of pulmonary tuberculosis. METHODS A systematic review of 11 randomized, comparative clinical trials published from 1959 to 1999 involving the use of prednisone, prednisolone and/or adrenocorticotrophin (ACTH) in conjunction with standard anti-tuberculosis chemotherapy. A total of 1814 steroid-treated patients were analyzed, most of whom had moderate to severe disease and cavitation. Clinical, microbiologic and radiographic outcome measures included time to defervescence, weight gain, normalization of serum albumin level and erythrocyte sedimentation rate, length of hospitalization, rate and rapidity of sputum conversion and radiographic regression of pulmonary infiltrates and cavities. RESULTS Corticosteroid therapy resulted in broad and significant clinical benefits in almost all of the studies reviewed. More rapid radiographic resolution of pulmonary infiltrates and, to a lesser extent, closure of cavities accompanied steroid use, especially in the first 4 months, but extended up to one year after initiation of treatment. Steroids did not have any appreciable effect on the speed or rate of sputum conversion. No detrimental side-effects attributed to steroid therapy or bacteriologic relapse were observed. CONCLUSION The adjunctive use of systemic corticosteroid therapy can safely provide significant early and prolonged clinical and radiographic benefits in selected patients with advanced pulmonary tuberculosis.