[Steroids in infection medicine]

Area of Science:

• Infectious Diseases
• Immunology
• Critical Care Medicine

Background:

• Corticosteroids are established adjunctive therapies for specific infections and hyperinflammatory diseases.
• Current guidelines recommend corticosteroids for tuberculous meningitis, pneumococcal meningitis, and immune reconstitution syndrome in patients on antiretroviral therapy.

Purpose of the Study:

• To review the current evidence and indications for corticosteroid use in various infectious and inflammatory conditions.
• To evaluate the emerging role of corticosteroids in severe COVID-19.
• To assess the evidence for routine corticosteroid use in conditions such as septic shock, community-acquired pneumonia, and tuberculous pericarditis.

Main Methods:

• Review of existing clinical trial evidence and practice guidelines.
• Analysis of data pertaining to corticosteroid efficacy in diverse patient populations and disease states.

Main Results:

• Corticosteroids are recommended for specific conditions including tuberculous meningitis, pneumococcal meningitis, and immune reconstitution syndrome.
• Severe COVID-19 is identified as a new potential indication for corticosteroid therapy.
• Insufficient clinical trial evidence currently supports the routine use of steroids in septic shock, community-acquired pneumonia, or tuberculous pericarditis.

Conclusions:

• Corticosteroids have a defined role in managing specific infectious and inflammatory conditions.
• The use of corticosteroids in severe COVID-19 warrants further investigation and consideration.
• Routine corticosteroid administration is not supported by current evidence for septic shock, community-acquired pneumonia, and tuberculous pericarditis.