Therapeutic Effect of Oral Prednisolone with Antitubercular Treatment in Pleural Effusion

SL* Shrestha

Abstract


Introduction: Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis and remains one of the major public health problems in Nepal. Currently 117 thousand people are living with TB in Nepal and 69 thousand new cases were registered at the National Tuberculosis Programme in 2018/19. Though nowadays National tubercular guidelines of Nepal does not recommend the use of corticosteroids in tubercular effusion, this study was to evaluate the outcome of corticosteroids in tubercular effusion as the previous study had shown its benefit on effusion. However its effect and benefit in various forms of TB are quite different.


Method: The study was carried out in the Medical department of National Academy of Medical Sciences, Bir Hospital, Nepal. This was a prospective, convenience sampling method with a study period of two years with all eligible and consenting individuals. This was the study of a total of 52 patients attending outdoor patient department (OPD) and wards who fulfilled the inclusion criteria.


Result: The first prednisolone response was evaluated in 14 days after the initiation of ATT. It was found that the level of effusion was decreased in all patients to some extent and there was complete resolution of effusion in 28 patients (26 male and 2 female) out of 52, with the early feeling of wellbeing, and improvement in the symptoms like fever, chest pain, and dyspnea. The second prednisone response was evaluated after one month of treatment, where 49 patients (94%) showed complete resolution of effusion, and 3 (6%) of them showed some extend pleural thickening due to poor adherence to prednisolone. The correlation between smoking and alcohol intake was done during the treatment of tubercular effusion and the p-value was calculated. It was found to be less than 0.05 which was significant.


Conclusion: Adjunctive proper use of oral prednisolone with the standard regime of ATT in tubercular effusion, resduces the chance of pleural thickening and also reduces the symptoms of fever, pleuritic chest pain, dyspnea earlier. However, the prednisolone should be used cautiously with ATT by justifying the risk-benefit of the treatment as it has many adverse effects.


Key words: Anti tubercular treatment, Pleural effusion, Prednisolone

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