9.3 Adjunctive corticosteroid therapy


Corticosteroids are indicated for:
– Meningitis of all stages of severity;
– Effusions: pleural effusion with severe respiratory difficulties; pericardial effusion;
– Compressions: laryngitis with obstruction of upper airways; urinary tract TB (in order to prevent ureteric stenosis); lymph node hypertrophy with bronchial or arterial compression;
– Severe hypersensitivity to TB drugs (although effectiveness has not been demonstrated);
– Life-threatening paradoxical reactions (immune reconstitution inflammatory syndrome) at the beginning of antiretroviral therapy or TB treatment (Chapter 12, Section 12.7)1 .

The suggested treatment is prednisolone PO (or prednisone) for 6 to 12 weeks according to the severity of symptoms and clinical response:
– Children: 2 mg/kg once daily in the morning, up to 4 mg/kg once daily in severely ill children (max. 60 mg once daily)
– Adults: 40 to 60 mg once daily in the morning

The dose should be tapered off in the last 2 weeks. For adults, decrease the dose by 5-10 mg every 2 to 3 days. Stopping the corticosteroids abruptly may result in adrenal crisis.



Footnotes
Ref Notes
1

Though corticosteroids are immunosuppressive, they may still be used safely in many HIV patients, depending on the immune status and concurrent infections. Never start corticosteroid treatment before anti-TB therapy.