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Steroid in infectious diseases. Dr Farhad Abbasi Infectious 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 ?.
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Steroid in infectious diseases Dr FarhadAbbasi Infectious diseases specialist
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
tuberculousmeningitis • 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
tuberculouspericarditis • Decreased mortality • Prednisolone 60 mg for 4 weeks • Prednisolone30 mg for 4 weeks • Prednisolone15 mg for 2 weeks
tuberculouspleuritis • 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: • Airway obstruction • Hemolytic anemia • Aplastic anemia • Severe thrombocytopenia • CNS involvement • Myocarditis/ pericarditis • Severe prolong prostration
208 patients • Age > 50 years and immunocompetent • Rash < 72 hours • Acyclovir & Prednisonefor 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