STEROID IN INFECTIOUS DISEASES

Dr Farhad AbbasiInfectious diseases specialist

STEROIDS AND INFECTIONS

Where?

When?

How much?

How long?

BACTERIAL MENINGITIS

Concomitant or before antibiotic therapy

Dose: 10 mg stat, 10 mg q6h for 2-4 day

Machanism?

Dexamethasone0.15 mg/kg IV q6°x4 days Reduced hearing loss 50 % decrease in mortality Decreased neurologic sequelae No adverse effects

de Gras and van de Beek. N EnglJ Med 2002;347:1549-1556

TUBERCULOUS MENINGITIS Improved patient survival Stage II and III Prednisolone 60-80 mg/day for 2 weeks with

tapering in 4 weeks

SEPTIC SHOCK

50 mg hydrocortisone q6 hours for 5 days

No survival benefit

We suggestIV hydrocortisone be given ONLY when unresponsive to fluid resuscitation and vasopressortherapy

Sprung et al. N EnglJ Med 2008;358(2):111-124

Dellinger et al. CritCare Med 2008;36(1):296-327

STEROIDS IN SEPSIS? Inconclusive evidence Diverging expert opinion New trials underway…. “Embrace Uncertainty”

Jaeschkeand Angus. 2009 JAMA;301(22):2388-2390

TUBERCULOUS PERICARDITIS

Decreased mortality Prednisolone 60 mg for 4 weeks Prednisolone 30 mg for 4 weeks Prednisolone 15 mg for 2 weeks

TUBERCULOUS PLEURITIS

Steroid hasten symptomatic improvement and fluid resorption but no long term benefit has been shown

SEVERE TYPHOID FEVER

Significant reduction in mortality Dexamethasone 3 mg/kg IV stat then 8 dose

of 1 mg/kg q6h In Pt with altered mental status or shock

INFECTIOUS MONONUCLEOSIS Steroid indiation:

1. Airway obstruction2. Hemolytic anemia3. Aplastic anemia4. Severe thrombocytopenia 5. CNS involvement6. Myocarditis/ pericarditis7. Severe prolong prostration

Prednisolone 60-80 mg/ day tarared in 1-2 weeks

HERPES ZOSTER

208 patients Age > 50 years and immunocompetent Rash < 72 hours Acyclovir & Prednisone for 21 days Improved quality of life measures, decreased

pain, better sleep, return to normal

Whitley et al. Ann Intern Med 1996;125:376-383.

Acyclovir 800 mg 5 times a day for 7 –10 days

ADD if age > 50 years Prednisone:

30 mg BID days 1 –7 15 mg BID days 8 –15 7.5 mg BID days 16 -21

PHARYNGITIS& STEROIDS

Meta-analysis 8 Trials: All 8 = earlier reduction in pain (range 5 hours –1 day) No difference in time off work/school No serious adverse events IM steroids no better than PO

Korbet al. Ann FamMed 2010:8:58-63

BELL’S PALSY

Herpes Simplex Virus Meta-analysis 18 trials ( 2786 patients ) Antivirals alone - Steroids alone + Antivirals AND steroids +++

deAlmediaet al. JAMA 2009;302:985-993.

PCP AND STEROIDS

Pneumocystisjiroveci

PaO2< 70 mm Hg Reduces respiratory failure and death Prednislone: 80 mg days 1-5 40 mg days 6-10 20 mg days 11-21