From the Guidelines
High-dose corticosteroid therapy is not generally recommended for treating fever alone, and its use should be reserved for specific conditions where the benefits outweigh the risks. When considering the use of corticosteroids, it's essential to weigh the potential benefits against the risks of adverse effects, such as increased risk of infections, blood sugar abnormalities, and electrolyte imbalances 1.
For specific conditions where corticosteroids may be indicated, such as severe inflammatory disorders or septic shock, the recommended dose and duration of treatment should be based on the most recent and highest quality evidence. According to the 2017 guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients, a long course and low dose of corticosteroids (e.g., IV hydrocortisone <400 mg/day for at ≥3 days at full dose) is suggested rather than a high dose and short course in adult patients with septic shock 1.
In the context of COVID-19, the evidence generally favors against the routine use of systemic corticosteroids, with concerns about increased likelihood of harm and lack of clear benefit 1. However, in specific situations where the patient has a high fever and feels unwell, the use of antibiotics and steroids may be considered on a case-by-case basis, with close monitoring and guidance from a healthcare professional 1.
It's crucial to note that corticosteroids should only be used under close medical supervision for specific indications, and not for routine fever management. When steroids are used, it's essential to monitor for adverse effects and taper the dose gradually to avoid adrenal insufficiency. Always addressing the underlying cause of fever rather than just treating the symptom with steroids is the best approach.
Some key points to consider when using corticosteroids include:
- Using the lowest effective dose and shortest duration of treatment necessary to achieve the desired effect
- Monitoring for adverse effects, such as increased risk of infections, blood sugar abnormalities, and electrolyte imbalances
- Tapering the dose gradually to avoid adrenal insufficiency
- Addressing the underlying cause of fever rather than just treating the symptom with steroids
- Reserving corticosteroid use for specific conditions where the benefits outweigh the risks, such as severe inflammatory disorders or septic shock.
From the Research
High-Dose Corticosteroid Therapy for Fever
- High-dose corticosteroid (steroid) therapy is not generally indicated for fever, except in specific cases where the fever is caused by an underlying condition that is responsive to steroids, such as certain autoimmune disorders or inflammatory conditions 2, 3.
- In cases of fever of unknown origin (FUO), steroid therapy may be effective in reducing fever and improving symptoms, but the underlying cause of the fever should be thoroughly investigated to rule out other potential causes 2.
- In patients with systemic lupus erythematosus (SLE), steroid therapy can suppress SLE fever, but it is essential to distinguish between SLE fever and infection fever, as infection fever may persist despite steroid therapy and can lead to severe sepsis if high-dose steroid therapy is continued 3.
- The use of steroid therapy in patients with severe fever with thrombocytopenia syndrome (SFTS) should be approached with caution, as it may increase the risk of complications and negatively impact survival, particularly in patients with mild disease or those who receive steroid therapy within 5 days of symptom onset 4.
- In general, the management of fever should be tailored to the individual patient's needs, taking into account the underlying cause of the fever, the patient's overall health status, and the potential risks and benefits of different treatment approaches 5, 6.