IDC New York

IDC New York

Source:

Creech CB. When to give corticosteroids and when not to. Presented at: Infectious Diseases in Children Symposium; Nov. 21-22, 2020 (virtual meeting).

Disclosures: Creech reports no relevant financial disclosures.
November 23, 2020
2 min read
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Steroids ‘one of the more vexing treatment modalities’ in pediatrics

Source:

Creech CB. When to give corticosteroids and when not to. Presented at: Infectious Diseases in Children Symposium; Nov. 21-22, 2020 (virtual meeting).

Disclosures: Creech reports no relevant financial disclosures.
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In a presentation during the virtual Infectious Diseases in Children Symposium, C. Buddy Creech, MD, MPH, called steroids “one of the more vexing treatment modalities in pediatrics.”

Creech, an associate professor of pediatrics and director of the Vanderbilt Vaccine Research Program at Vanderbilt University School of Medicine, gave examples of when and when not to administer corticosteroids in pediatric patients.

C. Buddy Creech

“While often anecdotally associated with symptomatic improvement in a variety of conditions, clinical trials have failed to support the routine use of corticosteroids except for very specific conditions,” said Creech, who is also an Infectious Diseases in Children Editorial Board Member.

Creech provided a list of adverse events to consider when prescribing corticosteroids to children:

  • Immunosuppression: “Immunosuppression in the setting of acute infection can be devastating depending on the pathogen.”
  • Mood changes: “For anyone who has taken steroids for any length of time, this is an almost universal phenomenon, particularly in school-aged children.”
  • Gastritis: “Gastritis is a real issue that can accompany and worsen the mood changes. This is one of the reasons why children on corticosteroids can have basically what looks like functional abdominal pain and high anxiety because of the mood changes.”
  • Sleep disturbance: Can usually be seen after 3 or 4 days.
  • Weight gain: Occurs with chronic use.
  • Suppression of endogenous production with prolonged use: “This is one of the reasons why, once steroids are used for several days, it's incredibly wise to provide a taper so that endogenous production can come back online.”

Creech said the immunologic side effects that can occur with steroid use are “very much dose dependent.” He noted a study showing that patients with rheumatoid arthritis were significantly more likely to experience a severe adverse event at a higher dose of prednisone (over 10 mg per day).

“Serious adverse events are ones that result in hospitalization, or a lasting comorbidity that might emerge, or worsening of a hospitalization if they're in-house,” he said. “These are real changes that will occur based on the dosing of corticosteroids.”

But prescribing corticosteroids “is a no-brainer” when dealing with either autoimmune or autoinflammatory diseases, Creech said.

He said corticosteroids are most frequently prescribed for dermatologic conditions, and noted that they can reduce inflammation in the lung in some infectious diseases, and “asthma exacerbations, for sure.” In clinical trials of patients with croup, dexamethasone or prednisone reduced airway inflammation, Creech noted.

“Therapy with steroids should not be a decision that's made lightly. So, that's [behind] the idea of just calling timeout and saying, ‘What do I want to do here? Let me pause for a second, think about what I really want to accomplish,’” Creech said. “What disease do I think the patient has? Is there a known indication for steroids there? Is there a bonafide need for steroid therapy?”