PREDNISONE AS ADJUNCTIVE THERAPY IN THE MANAGEMENT OF PULMONARY TUBERCULOSIS - REPORT OF 12 CASES AND REVIEW OF THE LITERATURE

A retrospective chart review was conducted over a 5-year period (1988 to 1993) in a tertiary inpatient care center on the effects of the add ition of prednisone to the treatment regimens of 12 patients with pulm onary tuberculosis who continued to spike high temperatures and lose w eight while showing bacteriologic response to effective antituberculos is therapy. After exclusion of other causes of fever, all patients wer e treated with 20 to 60 mg of prednisone daily until normalization of temperature and clinical improvement. Analyzed data included twice wee kly sputum bacillary count, temperature record every 4 h, weekly patie nt weight, serum albumin level, liver function tests, and chest roentg enogram. The patients continued to spike temperatures of 38.3 degrees C to 40.5 degrees C (mean+/-SD=39.6 degrees C+/-0.6 degrees C) even af ter 18 to 53 days (mean+/-SD=33.9+/-9.8 days) of antituberculosis ther apy. Within 24 h after the addition of oral prednisone, temperature de creased in all 12 patients from a daily highest spike mean of 39.6 deg rees C +/-0.6 degrees C(SD) to 38.1 degrees C+/-0.6 degrees C (SD) (p= 0.0022). The duration of required prednisone therapy was 20.1+/-9 days (mean+/-SD). During this period patients' appetites improved, and the ir weight increased from a mean (+/-SD) of 53.6+/-5.7 kg to 58.1+/-6.4 kg (p=0.0022). The serum albumin level increased from a mean (+/-SD) of 2.51+/-0.4 g/dL to 3.21+/-0.4 g/dL (p=0.0033). All the patients als o showed clinical evidence of a decrease in toxic reactions associated with tuberculosis. There were no side effects from the addition of pr ednisone. This study shows the need for randomized controlled clinical trials to clarify the role of prednisone as adjunctive therapy in the management of pulmonary tuberculosis.