CORTICOSTEROIDS IN TUBERCULOSIS

OBJECTIVE: To examine the effects of corticosteroids used for concomit ant disease states in patients with latent or active tuberculosis (TB) . The role of corticosteroids in the treatment of extrapulmonary TB is also discussed. DATA SOURCES: A MEDLINE search was conducted for the years 1953-1995. The International Pharmaceutical Abstracts service wa s also used to conduct an extensive literature review. In addition, re levant articles were cross-referenced to screen for additional informa tion. STUDY SELECTION/DATA EXTRACTION: During the literature review, e mphasis was placed on human studies and individual case reports. DATA SYNTHESIS: The resurgence of TB in this decade has affected many popul ations, especially immunocompromised patients. These patients may need corticosteroid therapy for various concomitant diseases that might pr edispose a patient to develop primary TB infection or reactivate laten t TB infection. In appropriate patients, prophylaxis with isoniazid is recommended. Corticosteroid therapy may benefit patients with some fo rms of extrapulmonary TB. After steroid therapy, improved survival and more rapid reduction of tuberculous symptoms have been noted in cases of tuberculous pleurisy, endobronchial TB, tuberculous meningitis, an d tuberculous pericarditis. Corticosteroids may also be useful in cont rolling both fever and hypersensitivity reactions in pulmonary and ext rapulmonary TB, although not routinely used for this purpose. CONCLUSI ONS: Corticosteroids may play an important role in TB infection by pro moting reactivation of latent infection. Corticosteroids may modify sy mptoms of some forms of extrapulmonary TB, although randomized, placeb o-controlled studies are needed before corticosteroids will have a def initive place in the standard therapy of TB.