Use of Corticosteroids in Treating Infectious Diseases

Abstract

linicians have generally avoided prescribing corticosteroids for active infection because of their known immunosuppressive effects and concern about long-term complications. We conducted a review of the published randomized, double-blind trials comparing corticosteroids and placebo in infections. Except in some trials of viral infections, sore throat, and cerebral cysticercosis, all patients also received active antimicrobial agents in addition to placebo or corticosteroids. For patients with bacterial meningitis, tuberculous meningitis, tuberculous pericarditis, severe typhoid fever, tetanus, or pneumocystis pneumonia with moderate to severe hypoxemia, treatment with corticosteroids improved patient survival (group 1 infections). For patients with bacterial arthritis, corticosteroids were also beneficial and reduced long-term disability (group 2 infections). For about a dozen other infections, corticosteroids significantly relieved symptoms (group 3 infections), and clinicians should consider using them if symptoms are substantial. Corticosteroids were harmful in 2 infections, viral hepatitis and cerebral malaria (group 5 infections). We conclude that corticosteroids are beneficial and safe for a wide variety of infections, although courses longer than 3 weeks should be withheld from patients with concomitant human immunodeficiency virus infection and low CD4 counts.

Malária álgida: um diagnóstico sindrômico

“…Entretanto, um único estudo realizado com nove pacientes com malária grave demonstrou insuficiência adrenal primária e secundária nessa forma mais complicada da doença 5 . É preciso ressaltar que as evidências de que o uso de corticóide intravenoso não promove impacto na mortalidade e de que aumenta o risco de sangramento gastrintestinal, na malária grave, se referem exclusivamente aos casos de malária cerebral 12 . Não existem estudos randomizados que avaliem a eficácia de corticóides em outras formas de gravidade da doença, em especial na malária álgida.…”

Corticosteroid therapy in acute respiratory distress syndrome

“…Pneumonia caused by specific infectious agents such as Pneumocystis jiroveci and tuberculosis are additional steroid-responsive illnesses to consider. 21 Although these illnesses are uncommon, in the absence of a clear risk factor for acute respiratory distress syndrome, their likelihood increases, and the potential for steroid responsiveness is an important consideration.…”

Claims for improved survival from systemic corticosteroids in diverse conditions: an umbrella review

“…For some conditions where corticosteroids are stated to have a 'classic' indication for use [1], such as severe tetanus or severe typhoid fever, the randomized evidence is minimal. For severe tetanus, there are two reported randomized trials from Turkey and India with 63 and 22 patients, respectively [39,40].…”