Study designs of evaluations included in the review
Randomised controlled trials (RCTs) were eligible for inclusion if they presented adequate and complete statistical information (no details were reported).
Specific interventions included in the review
Studies of adjunctive systemic corticosteroids were eligible for inclusion. The studies had to report sufficient information on the treatment regimens. Studies that solely used corticosteroids for the management of pleural TB were excluded, as were studies only using intralesional or endobronchial administration of corticosteroids. The included studies used prednisone, prednisolone and/or adrenocorticotrophin (ACTH) as adjunctive treatment to multi-drug combination anti-TB regimens. These regimens included combinations of two or more of the following drugs: isoniazid, para-aminosalicylic acid, streptomycin, pyrazinamide, rifampin and ethambutol. The main daily dose of prednisone or prednisolone was 31 mg (range: 16 to 60) and the mean ACTH dose was 40 units. Corticosteroids were given for a mean of 85 days (range: 30 to 180). The included studies administered treatment in in-patient and/or out-patient settings.
Participants included in the review
Studies in patients with PTB were eligible for inclusion if the patients were diagnosed by acid-fast or fluorochrome smear, or sputum culture. Most of the patients in the included studies had moderate to severe disease and cavitation.
Outcomes assessed in the review
Studies that reported sufficient details of clinical, bacteriological and roentgenographic outcomes were eligible for inclusion. The review defined clinical response as an improvement in at least one of the following: time to defervescence; weight gain; time to normalisation of serum albumin and/or erythrocyte sedimentation rate (ESR); and length of hospital stay. The review defined radiographic response as a moderate or greater improvement in the clearing of parenchymal infiltrates and in the time until closure of cavities.
In all of the included studies, at least two blinded radiologists independently read the radiographs; the radiologic outcomes were assessed after 2 weeks to 12 months. The included studies generally defined bacteriologic response as either a decrease in sputum bacillary count or conversion of sputum smear (using acid-fast stain or fluorescent microscopy), or a change in culture from positive to negative.
How were decisions on the relevance of primary studies made?
The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.