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Corticosteroid as an Adjunct in the Treatment of Endobronchial Tuberculosis: A Systematic Review & Meta-analysis

Author(s):

Nihar R. Mishra, Manoj K. Panigrahi, Girish C. Bhatt and Rashmi R. Das*   Pages 1 - 8 ( 8 )

Abstract:


Background: Corticosteroid exerts an anti-inflammatory action and can prevent tissue damage resulting from various causes. Studies have shown that corticosteroids may prevent the damaging effect of tuberculosis (TB) in various organs, but there is no published meta-analysis specifically looking for the effect of corticosteroid in endo-bronchial TB.

Objective: To synthesize the evidence regarding usefulness of corticosteroid in endo-bronchial TB.

Methods: A comprehensive search was performed of the major electronic databases till May 2018. Randomized trials comparing treatment with corticosteroid as an adjunct to anti-tubercular drugs (ATT) versus placebo/no treatment in endo-bronchial TB were included. Three authors independently applied eligibility criteria, assessed the studies for methodological quality, and extracted data. The review is registered at PROSPERO data base [CRD42016047063].

Results: Out of 525 search results, 4 trials including 205 patients (151 children) were eligible for inclusion. Oral prednisolone was used in various dose schedules. Rifampicin containing ATT regimen was used in 3 trials. The bronchoscopy score showed no significant improvement at 1 month (RR 0.06, 95% CI 0.00 to 1.00), 2 months (RR 1.26, 95% CI 0.89 to 1.8), and at completion of ATT (RR 0.63, 95% CI 0.1 to 4.14) in steroid treated group. The need for repeat bronchoscopy was significantly decreased in steroid group (RR 0.13, 95% CI 0.02 to 0.9). Among the adverse events, the infection rate was significantly lesser in steroid group (RR 0.53, 95% CI 0.29 to 0.97); but other adverse events (mortality, hypertension, and abdominal distension) showed no significant difference between the two groups. The GRADE evidence generated was of very low quality.

Conclusions: The present meta-analysis showed that oral steroid does not patients with endobronchial tuberculosis. However, the quality of evidence was very low. Future trials with robust design and larger sample size would be required to provide any firm recommendation regarding use of oral prednisolone in endobronchial tuberculosis.

Keywords:

Mycobacteria, anti-tubercular drugs, prednisolone, children, adults, evidence based medicine, bronchoscopy

Affiliation:

Department of Pediatrics, VIMSAR, Burla, Pulmonary Medicine, AIIMS, Bhubaneswar, Department of Pediatrics, AIIMS, Bhopal, Department of Pediatrics and Pulmonary Medicine, AIIMS, Bhubaneswar



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