1 / 29

Steroid in infectious diseases

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 ?.

dolan
Download Presentation

Steroid in infectious diseases

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Steroid in infectious diseases Dr FarhadAbbasi Infectious diseases specialist

  2. Steroids and Infections

  3. Where? • When? • How much? • How long?

  4. Bacterial meningitis • Concomitant or before antibiotic therapy • Dose: 10 mg stat, 10 mg q6h for 2-4 day • Machanism?

  5. 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

  6. tuberculousmeningitis • Improved patient survival • Stage II and III • Prednisolone 60-80 mg/day for 2 weeks with tapering in 4 weeks

  7. 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

  8. Steroids in Sepsis? • Inconclusive evidence • Diverging expert opinion • New trials underway…. • “Embrace Uncertainty” • Jaeschkeand Angus. 2009 JAMA;301(22):2388-2390

  9. tuberculouspericarditis • Decreased mortality • Prednisolone 60 mg for 4 weeks • Prednisolone30 mg for 4 weeks • Prednisolone15 mg for 2 weeks

  10. tuberculouspleuritis • Steroid hasten symptomatic improvement and fluid resorption but no long term benefit has been shown

  11. 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

  12. Infectious mononucleosis • Steroid indiation: • Airway obstruction • Hemolytic anemia • Aplastic anemia • Severe thrombocytopenia • CNS involvement • Myocarditis/ pericarditis • Severe prolong prostration

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

  14. Herpes Zoster

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. 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

More Related