Corticosteroids should be used as part of the treatment for TBM and may be used for the treatment of tuberculous pericarditis. Corticosteroids are sometimes used for other complicated forms of TB (e.g. complications of airway obstruction by TB lymph nodes; severely ill children and adolescents with disseminated TB), but there are no WHO recommendations regarding use of corticosteroids for forms of EPTB disease other than TBM and tuberculous pericarditis (102). Corticosteroids have been shown to improve survival and reduce morbidity in people with advanced TBM and are recommended for all children and adolescents with TBM (103) (Box 5.9).
Prednisone can be used at a dosage of 2 mg/kg/day orally, increased to 4 mg/kg/day in severely ill children and adolescents (e.g. with danger signs), with a maximum dosage of 60 mg/day for 4 weeks (102). The dose should then be reduced gradually over 2–4 weeks before stopping. Alternatively, dexamethasone 0.3–0.6 mg/kg/day can be used with a similar duration and by using the same method of gradual reduction in the dose (103).