[Corticosteroids: pharmacology and indications of short courses in pediatrics]

The principle of short courses of corticosteroids (SCC), ie, courses of less than 2 weeks, is to use the potent anti-inflammatory effect of corticosteroids. The pharmacological and pathophysiological basis of this anti-inflammatory effect are presented. Because they represent a very peculiar strategy of treatment, intravenous bolus dosages of methylprednisolone are not discussed. As compared to cortisol, the synthetic corticosteroids used in SCC (ie, mainly prednisone, prednisolone and betamethazone) have a more potent anti-inflammatory activity, a reduced mineralocorticoid effect and a longer biological half-life. The main indications of SCC are laryngitis and acute asthma. SCC are also indicated in bacterial meningitis, in addition to antibiotherapy. Other indications are Henoch-Schönlein purpura and intestinal inflammatory diseases. Adverse effects of SCC are uncommon. There are possible immunoallergic manifestations presenting mainly as skin reactions and sometimes as anaphylaxis. Abnormal psychological behaviour may be observed during the first 10 days of treatment. Few cases of ocular complications have been reported in adults, related to an increased intraocular pressure in patients with myopia or glaucoma. However, there is no evidence that SCC may cause gastric ulcer, nor that they may induce suppression of the adrenal function so that there is no need for a progressive decrease of the dosage when discontinuing the treatment.