Acth and Cortisone as Adjuncts in the Treatment of Advanced Pulmonary Tuberculosis

IN recent years it has been shown that the addition of steroid hormones to antimicrobial treatment can be beneficial in the management of over-whelming infections due to such organisms as meningococci, pneumococci, salmonellae, brucellae or klebsiellae.1'4 There has been little description of such combined treatment of severe tuberculosis in the American literature. Most authorities have pointed out the hazards of steroid therapy in the presence of active tuberculosis 5"7 except in tuberculous meningitis, where steroids are now part of the accepted management.8'9 This fear was first aroused when the use of steroids for nontuberculous diseases led to the activation of a cryptic tuberculous focus, with severe and sometimes fatal outcome.10*ll The rare reports on the use of steroids for known tuberculous processes were also discouraging.12 It should be emphasized, however, that such hormonal therapy was usually not covered by antituberculous drugs and, if such drugs were used, resistance was frequently present.18