RANDOMIZED TRIAL OF CORTICOSTEROIDS IN THE TREATMENT OF TUBERCULOUS PLEURISY

Background - Tuberculous pleurisy can result in pleural fibrosis, calc ification and thickening. To prevent these complications, corticostero ids are frequently used in addition to antituberculous drugs; however, new therapeutic regimens can control the disease and minimise the seq uelae, and there is no convincing evidence of the benefit of the use o f corticosteroids as adjuvant therapy. Methods - Patients received iso niazid 5 mg/kg and rifampicin 10 mg/kg daily for six months. Additiona lly, they were randomly assigned to a double blind treatment with eith er prednisone (1 mg/kg/day for 15 days and then tapering off) or place bo during the first month of treatment. Different clinical, radiologic al, and functional parameters were evaluated to assess the effect of c orticosteroids. Results - Fifty seven patients received prednisone and 60 placebo. At the end of the treatment the clinical outcome, the rat e of reabsorption of the pleural fluid, the pleural sequelae, as well as lung capacity were similar in both groups. Conclusions - Corticoste roids do not influence the clinical outcome or the development of long term pleural sequelae in tuberculous pleurisy.