Expert consensus on the rational use of glucocorticoids in tuberculosis treatment

doi:10.19982/j.issn.1000-6621.20210683

Abstract

Abstract:

Glucocorticoids have pharmacological effects of anti-inflammatory, anti-allergic, anti-bacterial endotoxin and immunosuppression, and can reduce immune damage caused by an allergic reaction to Mycobacterium tuberculosis.Glucocorticoids can quickly control the disease, but also can lead to adverse reactions such as dysbacteriosis, peptic ulcer, osteoporosis, and so on. There is still unreasonable use of glucocorticoids in the adjuvant treatment of tuberculosis in the clinic. Therefore, it is urgent to standardize the application of glucocorticoids in the treatment of tuberculosis.This consensus briefly introduces the advantages and basic principles of glucocorticoid therapy for tuberculosis, provides a recommendation of glucocorticoids used in the adjuvant treatment of tuberculous meningitis, tuberculous pericarditis, tuberculous pleuritis, tuberculous peritonitis, acute disseminated pulmonary tuberculosis, and caseous pneumonia under the strong and effective anti-tuberculosis treatment when necessary, and forwards the precautions, adverse reactions, and solution for the application of glucocorticoids. It is emphasized that more strict indications, the balance of advantages and disadvantages, rational use of glucocorticoids in the adjuvant treatment of tuberculosis.

Key words: Glucocorticoids, Tuberculosis, Therapeutic uses, Consensus development conferences as topic

CLC Number:

R521
R81

Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment /Institute for Tuberculosis Research/Department of Tuberculosis of the 8th Medical Center of Chinese PLA General Hospital, Editorial Board of Chinese Journal of Antituberculosis . Expert consensus on the rational use of glucocorticoids in tuberculosis treatment[J]. Chinese Journal of Antituberculosis, 2022, 44(1): 28-37. doi: 10.19982/j.issn.1000-6621.20210683

Figures/Tables 2

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证据	具体描述
质量等级
高	非常确信真实的效应值接近效应估计值
中	对效应估计值有中等程度的信心:真实值有可能接近估计值,但仍存在二者大不相同的可能性
低	对效应估计值的确信程度有限:真实值可能与估计值大不相同
极低	对效应估计值几乎没有信心:真实值很可能与估计值大不相同
推荐强度
强	支持使用某项干预措施的强推荐,干预措施明显利大于弊
弱	支持使用某项干预措施的弱推荐,干预措施可能利大于弊
弱	反对使用某项干预措施的弱推荐,干预措施可能弊大于利或利弊关系不明确
强	反对使用某项干预措施的强推荐,明确显示干预措施弊大于利

类别	药物	对糖皮质激素受体的亲和力比值	水盐代谢比值	糖代谢比值	抗炎作用比值	等效剂量 (mg)	血浆半衰期 (min)	作用持续时间(h)
短效	氢化可的松	1.00	1.0	1.0	1.0	20.00	90	8~12
	可的松	0.01	0.8	0.8	0.8	25.00	30	8~12
中效	泼尼松	0.05	0.8	4.0	3.5	5.00	60	12~36
	泼尼松龙	2.20	0.8	4.0	4.0	5.00	200	12~36
	甲泼尼龙	11.90	0.5	5.0	5.0	4.00	180	12~36
	曲安西龙	1.90	0.0	5.0	5.0	4.00	>200	12~36
长效	地塞米松	7.10	0.0	20.0~30.0	30.0	0.75	100~300	36~54
	倍他米松	5.40	0.0	20.0~30.0	25.0~35.0	0.60	100~300	36~54