Start with a free account for 3 free CME credits. Already a subscriber? Sign in.

Who Benefits from Steroids?

Bryan Hayes, PharmD and Mike Weinstock, MD
00:00
17:58
Sign in or subscribe to listen

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

Bryan and Mike discuss the myriad indications for steroids in the urgent care setting to determine when to give and when not to give. Both adult and pediatric patients are highlighted with a focus on dose and duration, when appropriate.

To view chapter written summaries, you need to subscribe.

Sign up today for full access to all episodes.

Ian L., Dr -

Another common complaint is Severe Rhino-sinusitis particularly in atopic people .
A study mentioned in the Cochrane Systemic Review April 2016 by K .Head examined corticosteroids plus antibiotics V's only antibiotics in children mean age 8 with Chronic Rhinosinusitis and the study found a lower symptom score and better CT scan scores of oral cortisone used for 15 days with antibiotics for 30 days
Mean disease severity with only antibiotics 15.2 with oral corticosteroids and antibiotics 3.2 .
The Cochrane analysis however regarded the Quality of the study as LOW and advised more stringent standards in future trials .

Mike W., MD -

This is a listener question from Dimitri:
I enjoyed the Feb 2020 UC Rap episode and I have two question son the steroid discussion. Is there benefit to taking steroids qd vs. tid or other dispersed dose? Also, does taking the steroids in the morning help reduce the incidence of insomnia side effect? Thanks for all your hard work.
dg

Reply from Weinstock:
Steroids have such a long half life that giving them once a day is my preferred method. You can try giving in the morning, but as the half life is so long, I don't think it would help and I have not heard about an advantage to it from the insomnia standpoint, though that is how I typically recommend they be taken; in the AM once a day w food. 40 mg. Keeps it easy!
M

Karen H. -

Hello, I reviewed your list of articles supporting this topic. I cannot find the reference for this statement: Single dose oral dexamethasone is equivalent in efficacy to 5 days of prednisolone for children with mild-moderate asthma exacerbations. I have been following the discussion of using this treatment for a few years, and have been waiting to do so.
Our director will not allow us to use single dose dexamethasone until there is date supporting it. Can you provide this?

Mike W., MD -

Here are some links for both pediatric and adult asthma (one time dose compared to 5 days of steroids):

Note: The original uc rap paper chase was April 2017:
Rehrer MW, et al. A Randomized Controlled Noninferiority Trial of Single Dose of Oral Dexamethasone Versus 5 Days of Oral Prednisone in Acute Adult Asthma. Ann Emerg Med. 2016 Nov;68(5):608-613. [PMID: 27117874]
BOTTOM LINE: A single dose of oral dexamethasone was not found to be non-inferior to 5 days of prednisone. However, the difference was small, and enhanced compliance and convenience may support the use of dexamethasone.

Here are a few other bits of info:
https://www.medpagetoday.com/blogs/epmonthly/62316
https://www.jwatch.org/na41200/2016/04/29/acute-asthma-single-dose-dexamethasone-vs-5-day-prednisone

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
Urgent Care RAP February 2020 Written Summary 1 MB - PDF

To earn CME for this chapter, you need to subscribe.

Sign up today for full access to all episodes and earn CME.

0.25 Free AMA PRA Category 1 Credits™ certified by Hippo Education

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate

3.25 AMA PRA Category 1 Credits™ certified by Hippo Education

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate