Meningitis: tuberculous: steroids reduce death and disability

Clinical bottom line (level 1a)

  1. Patients with tuberculous meningitis who receive steroids and TB chemotherapy compared with TB chemotherapy alone are less likely to die or disabling residual deficits (NN T = 10 at 6 months) .
Prasad et al: Cochrane Library 2000; 3 : -
Expires October 2004


The study

Systematic review of all randomised controlled trials of
  • Patients: tuberculous meningitis
  • Intervention: steroids (including hydrocortisone, prednisone, prednisolone, dexamethasone) by any route, with TB chemotherapy compared with TB chemotherapy alone
  • Outcome: death, disability

    Articles found in ?all using Medline, Cochrane Controlled Trials Database, Cochrane Infectious Diseases Group Trials Register, 1966-2000 (search terms: detailed in text )

    Selection criteria: detailed in text: performed by 2 independent reviewers
    Appraisal criteria: detailed in text: including concealment of randomisation, use of blinding, loss to follow-up, intention-to-treat analysis
    Articles excluded if:
    • quasi-randomisation


    6 trials involving 595 patients (5 adults, 1 child) followed for 3 months to 2 years
    Data was analysed using a random effects model.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NN T
    (95% CI)
    death 6 months 116/294
    (39.5%)    		 0.64
    (0.41 to 1.00)     		10
    (5 to infinity)
    death or disabling residual deficits 6 months 40/88
    (45.5%)    		 0.43
    (0.23 to 0.81)     		5
    (3 to 19)

    Comments

    1. The studies found had a number of problems making the results less certain. Funnel plots suggest there has been publication bias. Most studies were small and were open to selection bias due to inadequate concealment of randomisation.

    Citation

    1. Prasad K, Volmink J, Menon GR: steroids for treating tuberculous meningitis (Cochrane Review). Cochrane Library 2000; 3 : -
    Search Terms: mening* in Cochrane Library
    Contributor: Chris Ball, October 2001
    Reviewer:

    Clinical Question.
    Patient tuberculous meningitis
    Intervention or Exposure steroids and TB chemotherapy
    Comparison TB chemotherapy
    Outcome death, disability