Corticosteroid use in tuberculosis
Corticosteroids may have beneficial effects in patients with tuberculosis (TB) by suppressing harmful reactive immune responses such as immune reconstitution inflammatory syndrome, which can lead to compressive oedema.
Use corticosteroids as part of tuberculosis treatment in severely ill patients with extensive TB (eg those requiring intensive care support or those with respiratory failure or hypotension), and in the first 6 to 8 weeks of treatment of tuberculous meningitis and pericarditis.
Rifampicin increases the metabolism of (endogenous and exogenous) corticosteroids, reducing their activity. The corticosteroid dosages below are recommended when the patient is receiving rifampicin; for patients not receiving rifampicin, lower corticosteroid dosages will be required.
If oral corticosteroid therapy is suitable, a typical regimen for adults on a rifampicin-containing regimen is:
prednisolone (or prednisone) 60 mg orally, daily for 2 to 3 weeks, then taper the dose gradually over 4 to 6 weeks according to clinical response. tuberculosis (adult) prednis ol one
For children on a rifampicin-containing regimen, a typical oral regimen is:
prednisolone (or prednisone) 2 to 4 mg/kg up to 60 mg orally, daily for 4 weeks, then taper the dose gradually over 1 to 2 weeks according to clinical response. tuberculosis (child) prednis ol one
Use the higher end of the dose range for children who are severely ill.
For critically ill adults and children who require intravenous corticosteroids, a suggested regimen for those on a rifampicin-containing regimen is:
dexamethasone 0.4 mg/kg intravenously, daily for 7 days, then tuberculosis dexamethasone
dexamethasone 0.3 mg/kg intravenously, daily for 7 days, then
dexamethasone 0.2 mg/kg intravenously, daily for 7 days, then
dexamethasone 0.1 mg/kg intravenously, daily for 7 days
FOLLOWED BY
dexamethasone 4 mg (child: 0.08 mg/kg) orally, daily; decreasing by 1 mg (child: 0.02 mg/kg) every 7 days1. dexamethasone