[Evaluation of fixed glucocorticoid-antibiotic combinations]

Fixed combinations of glucocorticoids and antibiotics are widely used for the treatment of bacterial infections because they can cause a rapid relief of the inflammatory symptoms. However, hitherto a decisive improvement of the clinical efficacy of the combination as compared to single antibiotic therapy could not be proved. Without a real clinical advantage the combined use of glucocorticoids causes severe side effects like immune suppression with increased risk of infections, gastrointestinal lesions and depression of endogenous hydrocortisone which all will occur even after short-term use and may last for several weeks. Glucocorticoids exhibit a markedly longer duration of action than antibiotics with the risk of cumulation of the glucocorticoid. Thus, there is no kinetic compatibility as it has to be claimed for a rational combination. Due to the negative risk-benefit relation the systemic use of such combinations has to be rejected. For the topical treatment of skin disorders, however, the short-term use of combinations of corticosteroids and antibiotics with comparable pharmacokinetics on the skin like aminoglycoside antibiotics can be of clinical benefit.