9.5 Adjunctive therapy

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    9.5.1 Pyridoxine prophylaxis

    Pyridoxine (vitamin B6) prophylaxis is indicated for all patients at risk of peripheral neuropathy, i.e. pregnant or breastfeeding women and patients with HIV infection, chronic alcohol use, malnutrition, diabetes, chronic hepatic disease or renal impairment (see Peripheral neuropathy, Appendix 17).

    9.5.2 Corticosteroid therapy

    Corticosteroid therapy is indicated for:

    • TB meningitis [1] Citation 1. Burch Jane, Eisenhut Michael. What effect do adjunctive corticosteroids have on mortality and disability in people with tuberculous meningitis? Cochrane Clinical Answers 2016. and pericarditis [2] Citation 2. Wiysonge CS, Ntsekhe M, Thabane L, Volmink J, Majombozi D, Gumedze F, Pandie S, Mayosi BM. Interventions for treating tuberculous pericarditis. Cochrane Database Syst Rev. 2017 Sep 13;9(9):CD000526.
      https://doi.org/10.1002/14651858.CD000526.pub2             ;
    • Treatment and prevention of TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). See Chapter 12.

     

    There is insufficient evidence regarding the use of corticosteroids in other indications [3] Citation 3. Schutz C, Davis AG, Sossen B, et al. Corticosteroids as an adjunct to tuberculosis therapy. Expert Rev Respir Med. 2018;12(10):881-891.
    https://doi.org/10.1080/17476348.2018.1515628         [4] Citation 4. Kadhiravan T, Deepanjali S. Role of corticosteroids in the treatment of tuberculosis: an evidence-based update. Indian J Chest Dis Allied Sci. 2010 Jul-Sep;52(3):153-8. PMID: 20949734. .

     

    Table 9.3 – Corticosteroid treatment

     

    Indications

    Dosage and duration

    TB meningitis [5] Citation 5. BMJ Best Practice. Extrapulmonary tuberculosis [Accessed 01 March 2023].

     

    dexamethasone IV/PO

    Child: 0.6 mg/kg once daily for 4 weeks, tapered off over 4 weeks

    Adult: 0.4 mg/kg once daily for 7 days, tapered off over 6 to 8 weeks

    TB pericarditis

     

    prednisolone PO

    Child: 1.5 mg/kg once daily for 4 weeks, tapered off over 6 weeks

    Adult: 60 mg once daily for 4 weeks, tapered off over 6 weeks
     

     

    References
    • 1.Burch Jane, Eisenhut Michael. What effect do adjunctive corticosteroids have on mortality and disability in people with tuberculous meningitis? Cochrane Clinical Answers 2016.
    • 2.Wiysonge CS, Ntsekhe M, Thabane L, Volmink J, Majombozi D, Gumedze F, Pandie S, Mayosi BM. Interventions for treating tuberculous pericarditis. Cochrane Database Syst Rev. 2017 Sep 13;9(9):CD000526.
      https://doi.org/10.1002/14651858.CD000526.pub2
    • 3.Schutz C, Davis AG, Sossen B, et al. Corticosteroids as an adjunct to tuberculosis therapy. Expert Rev Respir Med. 2018;12(10):881-891.
      https://doi.org/10.1080/17476348.2018.1515628
    • 4.Kadhiravan T, Deepanjali S. Role of corticosteroids in the treatment of tuberculosis: an evidence-based update. Indian J Chest Dis Allied Sci. 2010 Jul-Sep;52(3):153-8. PMID: 20949734.
    • 5.BMJ Best Practice. Extrapulmonary tuberculosis [Accessed 01 March 2023].
    Path