Effect of Corticosteroids in Tubercular Pleural Effusion- A Randomised control trial

<bold>Background:</bold> Evidence of role of corticosteroids in Tubercular Pleural Effusion is unclear and merits further investigation <bold>Aims and Objective:</bold> To study the effect of corticosteroids in patients with tubercular pleural effusion with regards to (i) rate of radiological and symptomatic resolution (ii) adverse events; measured between two groups- Standard care + oral corticosteroids (Group A) vs standard care alone (Group B) <bold>Hypothesis:</bold> Oral prednisolone, due to its anti-inflammatory and fibrinolytic properties, shortens the period of absorption of fluid, when given with anti-tubercular drugs <bold>Methods:</bold> 50 patients diagnosed with Tubercular pleural effusion on the basis of clinical and biochemical parameters were randomly allocated into one of the two groups- Group A and Group B. Patient undergoing therapeutic thoracentesis were excluded. Group A received oral corticosteroids in addition to standard care. Standard care was treatment for TB effusion as per national guideline. Radiological resolution was determined by change in fluid level estimated from monthly Chest X-rays <bold>Result:</bold> 50 patients were randomized to two groups- Group A (n=25) and Group B (n=25). Commonest age group for TB pleural effusion was 21-31 years (36%), 70% were males. Right sided effusion was more common than left(64% vs 36%). <bold>At 1 month- 80% in group A had complete radiological resolution vs only 32% in Group B.</bold> <bold>At 6 month-</bold> 96% patients in group A and 80% patients in group B showed complete clearance on CXR. Group A patients had faster resolution of symptoms (median- 13 days vs 23 days), more improvement in ESR (at 2 months)-15.96±3.8 vs 25.96±11.2 compared to the Group B. 14% patients in Group A had steroid related adverse effects.