Re-evaluate when SHORT-term steroid use is needed
New concerns will raise questions about when it's appropriate to use SHORT courses of oral corticosteroids in adults. We know long-term steroid use can lead to adverse effects, such as osteoporosis and weight gain. And using a steroid for just a few days can cause hyperglycemia, insomnia, etc. Now evidence links steroid use for just one week to a slightly higher 3-month risk of fractures, venous thromboembolism, and sepsis. But these findings may be due to other factors, such as the patient's underlying condition. Use this as an opportunity to re-evaluate short-term oral steroids...
For example, don't use short-course steroids in the emergency department (ED) for acute sinusitis, bronchitis, or sore throat. In most cases, steroids reduce symptoms by one day at most and potential risks may outweigh benefits. But continue to use 5 days of a steroid for an asthma or COPD exacerbation to help reduce relapse or hospitalization. Or consider steroids for patients admitted with community-acquired pneumonia to help reduce length of hospitalization. Get our note "Consider using steroids for community acquired pneumonia (CAP) patients".
Don't automatically give a methylprednisolone dose pack (Solu-Medrol, etc) if a short-course steroid is needed. Once-daily prednisone works just as well, is simpler and costs less. Keep in mind, tapering usually isn't needed for short courses of steroids.
References
- Waljee, A.K., et al. (2017). Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ, p.j1415.
- Venekamp RP, Thompson MJ, Hayward G, Heneghan CJ, Del Mar CB, Perera R, Glasziou PP, Rovers MM. Systemic corticosteroids for acute sinusitis. Cochrane Database Syst Rev. 2014 Mar 25;(3):CD008115.