Prednisolone: A beneficial and safe adjunct to antituberculosis treatment? A randomized controlled trial
International Journal of Tuberculosis and Lung Disease, cilt.3, sa.1, ss.47-54, 1999 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 3 Sayı: 1
- Basım Tarihi: 1999
- Dergi Adı: International Journal of Tuberculosis and Lung Disease
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.47-54
- Anahtar Kelimeler: pulmonary tuberculosis, prednisolone, toxic reactions
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
SETTING: A referral centre for thoracic diseases in Izmir, Turkey, 1992- 1995. OBJECTIVE: To appriase the adjunctive role of prednisolone (PN) in pulmonary tuberculosis (PTB) with toxic reactions. DESIGN: After excluding other febrile causes, and 2 weeks of four/five-drug antituberculosis therapy insufficient to resolve toxic reations, 178 human immunodeficiency virus (HIV) negative patients with advanced PTB causing persistent high-grade fever (≥38°C), weight loss (≥2 kg/week) and/or low serum albumin levels (<3 g/dL) were randomly allocated to receive either a 12-month course of antituberculosis treatment using four first-line drugs and PN (20 mg b.i.d. IV/IM initially, decreasing over 40 days) (91 patients-PN group), or 12 months of antituberculosis treatment by (87 patients-CO group). Twice-weekly sputum bacillary count, temperature recorded every 6 hours, weekly weight, serial albumin level and liver function measurements and chest roentgenograms were used to assess the effectsof PN on PTB. RESULTS: Temperature decreased from 39.1 ± 0.9°C to 37.9 ± 0.7°C (P = 0.0030) within the first 72 (±9) hours in those patients on PN treatment, whereas a gradual decline occurred over 22 (±3) days in the CO group. In the PN group, patients' weight increased from 49.7 ± 4.8 kg to 56.9 ± 8.3 kg, compared to 47.1 ± 6.4 kg to 51.3 ± 5.9 kg in the CO group (P = 0.0022). Increases in serum albumin levels in the PN and CO groups were from 2.26 ± 0.8 g/dL to 3.32 ± 0.6 g/dL and from 2.31 ± 0.5 g/dL to 2.90 ± 0.7 g/dL, respectively (P = 0.0035). The radiographic regression and drop in bacillary count were more rapid, and the hospital stay shorter (53.4 ± 3.1 days vs 71.3 ± 5.6 days) in the PN group, although there were no differences in the acid-fast bacilli conversion rates. There were no detrimental side effects and relapses attributable to PN during the 1-3 year follow-up, even in 18 cases with drug resistance. CONCLUSION: Prednosolone is a beneficial and safe adjunct to 12-month antiberculosis treatment in advanced PTB causing toxic reactions, provided that close clinical, radiographic and bacillary monitoring is exercised.