When did a steroid dose become common place when dealing with URI's and pneumonia?

I come from transplantation and we wielded steroids like a damn light sabre. Heavily and frequently. I came to dislike them though they were a necessary evil.

I was in for a sinus infection three weeks ago. Recommendation, a butt full of steroids and antibiotics (oral).

Had the wife in today for crud. Same deal.

Seems a bit counter-productive in my mind.

Is this a common practice now? On one hand, the patients probably feels better sooner; on the other hand, steroids can really screw some people up.

What are you seeing?

Thanks,

RMD

There’s a ton of URI’s with reactive airway or badly swollen tonsils. The roids help in both regards. Decadron is my go to in the ER for a quick fix for bad wheezing and such. Also the gold standard for kids with croup. If you aren’t wheezing or have at least + 3 tonsils I usually don’t use steroids. This time of year all your asthmatics and COPD’ers are hit hard. Steriod tapers and bronchodilators all day every day.

Steroids are a necessary evil for short term and long term if indicated. They work great for URI along with antibiotics, bronchodilators, if needed I don’t think the dose pack does much. Maybe for someone relatively healthy, but for others a larger regimen is needed. Every couple months I need a larger tapering dose. As long as you don’t go over the 2 week threshold of 40 mg daily you’ll be OK. My friend who is a Pulmonolgist says they don’t worry about tapering until it’s 40mg for 2weeks. I usually do 40x3, 30 x3, 20x3, 10x3, then a day or 2 of 5. But then, I’m taking them for different reasons. It is a wonder drug if you don’t need them often.

The majority of therapies for URIs (sinusitis, bronchitis, tonsillitis, pharnyngitis) don't do squat for symptoms. I'm referring to antibiotics (these are almost entirely viral illnesses), cough medicines (make you sleepy maybe, but all are really ineffective at cough suppression). Steroids, on the other hand, work wonders to decrease the inflammatory responses - less airway edema, decrease painful sore throats, and generally knock back some of the bodies inflammatory responses which tend to cause a lot of the symptoms associated with URIs. There are problems with this, they may impair the immune system's ability to clear an infection, though with short courses and the majority of URIs this is not an issue. They can lead to other unpleasant side effects as well, including psychosis. So, like all therapies, the risks and benefits must be weighed. Personally, I use them a fair amount in my practice, though not for a run of the mill URI. Usually 40mg of prednisone daily for 5 days.

quote:

There are problems with this, they may impair the immune system's ability to clear an infection, though with short courses and the majority of URIs this is not an issue.

This was my precise concern.

This wasn't viral any longer. Turns out she has a mild case of pneumonia and is on antibiotics for that. She's a bit better this AM and I will continue to watch her and see that she gets better.

Thanks for all the replies.

RMD