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Corticosteroids for tuberculous pleurisy
M E Engel1, P T Matchaba, J Volmink
1Faculty of Health Sciences, University of Cape Town, Department of Medicine, J47 Old Main Building, Groote Schuur Hospital, Observatory, South Africa, 7925. mark.engel@mrc.ac.za
The Cochrane Database of Systematic Reviews
|October 19, 2007
Summary
Corticosteroids may reduce pleural fluid and thickening in tuberculous pleurisy but lack evidence for mortality benefits. Further research is needed, especially regarding adverse effects in HIV-positive individuals.
Area of Science:
- Infectious Diseases
- Pulmonology
- Clinical Medicine
Background:
- Tuberculous pleurisy treatment often involves antituberculous therapy.
- Adjunctive corticosteroids have shown inconsistent benefits and potential risks, particularly in HIV-positive patients.
Purpose of the Study:
- To evaluate the efficacy and safety of adding corticosteroids to standard antituberculous drug regimens for tuberculous pleural effusion.
Main Methods:
- Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
- Searched multiple databases including Cochrane, MEDLINE, and EMBASE up to May 2007.
- Data extraction and analysis using relative risks and weighted mean differences with 95% confidence intervals.
Main Results:
- Corticosteroids reduced residual pleural fluid at four weeks and pleural thickening.
- No significant effects were observed on mortality, respiratory function, or pleural adhesions.
- Increased treatment discontinuation due to adverse events was noted, with a potential increased risk of Kaposi sarcoma in HIV-positive individuals.
Conclusions:
- Insufficient evidence exists to recommend adjunctive corticosteroids for tuberculous pleurisy.
- Further high-powered randomized controlled trials are necessary to assess effects on morbidity and mortality.
- The impact of corticosteroids on HIV-related complications requires specific investigation.
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