Steroids for acute bronchitis

Members: Robert Bortolussi MD; Natalie A Bridger MD; Jane C Finlay MD; Susanna Martin MD (Board Representative); Jane C McDonald MD; Heather Onyett MD; Joan Louise Robinson MD (Chair)
Liaisons: Upton D Allen MD, Canadian Pediatric AIDS Research Group; Michael Brady MD, Committee on Infectious Diseases, American Academy of Pediatrics; Janet Dollin MD, College of Family Physicians of Canada; Charles PS Hui MD, Committee to Advise on Tropical Medicine and Travel, Public Health Agency of Canada; Nicole Le Saux MD, Immunization Monitoring Program, ACTive (IMPACT); Dorothy L Moore MD, National Advisory Committee on Immunization (NACI);  John S Spika MD, Public Health Agency of Canada
Consultant: Noni E MacDonald MD
Principal author: Charles PS Hui MD

The adverse effects of corticosteroids in pediatric patients are similar to those in adults (see ADVERSE REACTIONS ). Like adults, pediatric patients should be carefully observed with frequent measurements of blood pressure, weight, height, intraocular pressure, and clinical evaluation for the presence of infection, psychosocial disturbances, thromboembolism, peptic ulcers, cataracts, and osteoporosis. Pediatric patients who are treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in their growth velocity. This negative impact of corticosteroids on growth has been observed at low systemic doses and in the absence of laboratory evidence of HPA axis suppression (., cosyntropen stimulation and basal cortisol plasma levels). Growth velocity may therefore be a more sensitive indicator of systemic corticosteroid exposure in pediatric patients treated with corticosteroids should be monitored, and the potential growth effects of prolonged treatment should be weighed against clinical benefits obtained and the availability of treatment alternatives. In order to minimize the potential growth effects of corticosteroids, pediatric patients should be titrated to the lowest effective dose.

Staging is not used for ALL, because it is spread throughout the body when first diagnosed. There is a system to classify ALL as high-risk, standard or low-risk. It is important to stress that this refers to the chance of a good response following standard treatment. If treatment is selected according to risk group, many patients with high-risk disease will do very well. It is also, unfortunately, not always true that a patient with low risk disease will do well. The risk group is only of the factors which affects the outcome of treatment.

Caveats: The trials included here are, in aggregate, relatively small, and compared different corticosteroids, given at different doses, using different routes of administration. Most of the trials used a single dose of dexamethasone, and in the trials that compared routes, there was no significant difference in symptoms between oral and intramuscular injection. In addition, seven of eight trials allowed but did not control for other analgesics. Antibiotics were co-administered with and without steroids, and no studies assessed the efficacy of steroids in the absence of antibiotics. As the majority of pharyngitis cases are viral in etiology and do not benefit significantly from antibiotics 5 , studies assessing the efficacy of steroids in the absence of antibiotics would be useful.

Finally, steroids in general are well tolerated, particularly with short term use, but there are known adverse effects such as hyperglycemia and mood changes. 6 While no harms were identified in this analysis, and although they may be rare, the trials included here were underpowered to detect adverse events.

Only two of the included studies focused on pediatric patients, and together yielded mixed results. In addition, there are reported cases in which steroids have masked acute leukemia in pediatric patients presenting with sore throat. 7 Thus, further study in children is warranted.

Steroids for acute bronchitis

steroids for acute bronchitis

Caveats: The trials included here are, in aggregate, relatively small, and compared different corticosteroids, given at different doses, using different routes of administration. Most of the trials used a single dose of dexamethasone, and in the trials that compared routes, there was no significant difference in symptoms between oral and intramuscular injection. In addition, seven of eight trials allowed but did not control for other analgesics. Antibiotics were co-administered with and without steroids, and no studies assessed the efficacy of steroids in the absence of antibiotics. As the majority of pharyngitis cases are viral in etiology and do not benefit significantly from antibiotics 5 , studies assessing the efficacy of steroids in the absence of antibiotics would be useful.

Finally, steroids in general are well tolerated, particularly with short term use, but there are known adverse effects such as hyperglycemia and mood changes. 6 While no harms were identified in this analysis, and although they may be rare, the trials included here were underpowered to detect adverse events.

Only two of the included studies focused on pediatric patients, and together yielded mixed results. In addition, there are reported cases in which steroids have masked acute leukemia in pediatric patients presenting with sore throat. 7 Thus, further study in children is warranted.

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