REPLY
Special Problems in Treating Tuberculosis
Peter Barnes, MD
1 March 1994 | Volume 120 Issue 5 | Pages 440-441
IN RESPONSE:
Drs. Salomon, Perlman, and Goldstein present their experience with ofloxacin, ethambutol, and an aminoglycoside in HIV-infected patients with tuberculosis who developed hepatotoxicity while receiving standard antituberculous therapy. My limited experience with this combination therapy in patients with tuberculosis and without HIV infection also suggests that this regimen is adequate to keep the disease under control until the patient can tolerate more standard agents. We agree that additional evaluation of the microbiologic efficacy of this combination is needed.
I disagree with Dr. Johnson that corticosteroids should be used liberally in patients with tuberculous pericarditis because of methodologic concerns in the trial cited [1]. This report combined results of two separate trials to obtain the groups who did and did not receive prednisolone. The baseline features were not reported for the placebo and prednisolone groups, so it remains uncertain whether the severity of pericarditis was similar. Finally, the lower death rate from pericarditis in patients treated with prednisolone (2 of 76 patients [3%] compared with 10 of 74 patients [14%]) has wide confidence intervals, despite its statistical significance. I believe that the findings in this and a previous trial [2] suggest that corticosteroids benefit a subpopulation of patients with tuberculous pericarditis. In the absence of any definitive evidence, I prefer to reserve treatment with corticosteroids for severely ill patients, in whom the benefit-to-risk ratio is likely to be high.
|
Author and Article Information
|
|---|
University of Southern California School of Medicine; Los Angeles, CA 90033
1. Strang JI, Gibson DG, Mitchison DA, Girling DJ, Kakaza HH, Allen BW, et al. Controlled clinical trial of complete open surgical drainage and of prednisolone in treatment of tuberculous pericardial effusion in Transkei. Lancet. 1988; 2:759-64.
2. Strang JI, Gibson DG, Nunn AJ, Kakaza HH, Girling DJ, Fox W. Controlled trial of prednisone as adjuvant in treatment of tuberculous constrictive pericarditis in Transkei. Lancet. 1987; 2:1418-22.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
Author & Article Info
References
Article
