What systemic steroids, such as prednisone (corticosteroid), assist with symptoms of unexplained chills and mild upper respiratory infection (URI) symptoms?

Systemic Steroids for Chills and URI Symptoms

For mild upper respiratory infection symptoms with chills, a short course of oral prednisone at 25-50 mg daily for 3-5 days can effectively reduce symptom duration, particularly fever and chills. 1, 2

Evidence-Based Recommendation

Systemic corticosteroids can provide symptomatic relief for URI symptoms through their potent anti-inflammatory effects. The most recent evidence suggests:

• Prednisone is the preferred systemic corticosteroid for URI symptoms with chills
• Dosing typically ranges from 25-50 mg daily for 3-5 days
• Effects on symptom relief can be seen as early as the day after the first dose 2

Mechanism of Action

Corticosteroids work by:

• Reducing inflammatory cytokine production
• Decreasing inflammatory response in respiratory mucosa
• Suppressing immune system hyperactivity that contributes to symptoms

Clinical Evidence

According to available guidelines, systemic corticosteroids have demonstrated effectiveness in reducing fever duration in respiratory infections. A meta-analysis showed that the duration of fever was significantly lower in patients who received corticosteroids compared to those who did not (weighted mean difference = -3.2 days) 1.

While not recommended for routine use in all URI cases, short courses of systemic corticosteroids have shown benefit in:

• Reducing duration of symptoms
• Decreasing severity of chills and fever
• Providing symptomatic relief when other treatments are insufficient

Specific Recommendations

For unexplained chills with mild URI symptoms:

1. First-line option: Prednisone 25 mg daily for 3-5 days

   • Can be increased to 50 mg daily for more severe symptoms
   • Effects often noticeable within 24 hours of first dose

2. Alternative option: Methylprednisolone 30-80 mg daily for 3-5 days (if oral administration is not possible) 1

3. Dexamethasone: Can be considered at 0.3-0.6 mg/kg daily for 1-5 days as an alternative 3

Important Precautions

Systemic corticosteroids carry potential risks that must be considered:

• Immunosuppression: Corticosteroids suppress the immune system and may increase risk of infection 4
• Masking of infection signs: May hide symptoms of worsening infection
• Adrenal suppression: Even short courses can affect the hypothalamic-pituitary-adrenal axis
• Metabolic effects: Can cause elevation of blood pressure, salt and water retention 4

When to Avoid

Systemic corticosteroids should be avoided or used with extreme caution in:

• Active untreated infections (particularly fungal)
• Patients with latent tuberculosis without chemoprophylaxis
• Uncontrolled diabetes
• Recent exposure to varicella or measles in non-immune patients 4

Monitoring

When administering systemic corticosteroids for URI symptoms:

• Monitor for symptom improvement within 24-48 hours
• Watch for signs of secondary infection
• Discontinue if no improvement after 3 days
• No tapering is typically needed for short courses under 7 days

The evidence suggests that a short course of systemic corticosteroids can be effective for managing unexplained chills and mild URI symptoms, particularly when other symptomatic treatments have been insufficient.