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[Glucocorticoids and infection].

F J Frey1, R F Speck

  • 1Medizinische Poliklinik, Universität Bern.

Schweizerische Medizinische Wochenschrift
|February 1, 1992
PubMed
Summary
This summary is machine-generated.

Glucocorticosteroids are common immunosuppressants. Low doses (under 10mg daily) don't increase infection risk, but higher doses do, influenced by the underlying disease.

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Area of Science:

  • Immunology
  • Pharmacology
  • Infectious Diseases

Background:

  • Glucocorticosteroids are widely used immunosuppressants.
  • Understanding their impact on infection risk and therapeutic benefits is crucial.

Purpose of the Study:

  • To review glucocorticoid mechanisms, analyze infection risks versus dose/duration, and assess their efficacy as adjunctive therapy in infections.

Main Methods:

  • Meta-analysis of 73 controlled clinical trials.
  • Analysis of dose-response relationships and specific infectious disease contexts.

Main Results:

  • Infectious complications were not elevated below 10mg daily or 700mg cumulative prednisone dose.
  • Higher doses increased infection rates in both corticosteroid and placebo groups.

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  • Beneficial effects observed in pulmonary tuberculosis, constrictive pericarditis, and Pneumocystis pneumonia in AIDS patients.
  • No benefit in septic shock or ARDS; controversial in bacterial meningitis.
  • Harmful in hepatitis B and cerebral malaria; beneficial for postherpetic neuralgia in the elderly.

    • Conclusions:

    • Glucocorticoid immunosuppression is dose-dependent regarding infection risk.
    • Therapeutic benefits are disease-specific, requiring careful risk-benefit assessment.
    • Underlying disease severity significantly influences infection risk alongside corticosteroid use.