Corticosteroid use in TB Pericarditis and TB Meningitis

TB Pericarditis:

• For adults, the regimen is prednisone 60 mg/day (or the equivalent dose of prednisolone) given for four weeks, followed by 30 mg/day for four weeks, 15mg/day for two weeks, and 5 mg/day for one week. 

TB Meningitis:

• Glucocorticoid regimen — Either dexamethasone or prednisone may be used, as follows:

Dexamethasone 

• Children weighing <25 kg: 8 mg/day for two weeks, then taper gradually over four to six weeks
• Adolescents and adults >25 kg: 0.3-0.4mg/kg/day for two weeks, then 0.2 mg/kg/day week three, then 0.2 mg/kg/day week four, then 4 mg per day and taper 1 mg off the daily dose each week
• total duration approximately eight weeks.

Prednisone 

*Reference: UPTODATE (CNS TB)

• Children: 2 to 4 mg/kg per day
• Adolescents and adults: 60 mg/day.
• Administer initial dose for two weeks, then taper gradually over the next six weeks (ie reduce daily dose by 10 mg each week)
• total duration approximately eight weeks.

*Reference: Sarawak Emergency Handbook 3^RD Edition

• Adult:0.4mg/kg/day (in 3 divided doses) for week 1, then 0.3 mg/kg/day for week 2, then 0.2 mg/kg/day for week 3,then 0.1 mg/kg/day foe week 4, then 4 mg per day and tail of 1 mg per week for the following 4 weeks. 

References:

1. www.uptodate.com
2. Sarawak Emergency Handbook 3^RD Edition