From the Guidelines
Oral corticosteroids are not recommended for routine treatment of upper respiratory infections (URIs). For most viral URIs, including the common cold, sinusitis, and bronchitis, steroids like prednisone or dexamethasone provide minimal benefit while carrying risks of side effects such as increased blood sugar, mood changes, and immune suppression 1. Instead, symptomatic treatment with rest, hydration, acetaminophen or NSAIDs for pain and fever, and possibly over-the-counter decongestants or antihistamines is preferred.
Key Considerations
- The exception is croup in children, where a single dose of dexamethasone (0.6 mg/kg, maximum 10 mg) can significantly reduce airway inflammation and improve symptoms.
- For allergic rhinitis, intranasal corticosteroids like fluticasone (1-2 sprays per nostril daily) may be appropriate, as suggested by the ARIA guidelines 1.
- Steroids work by suppressing inflammation, but for most URIs, this anti-inflammatory effect doesn't significantly improve outcomes and doesn't address the underlying viral cause.
- Antibiotics are also not indicated for viral URIs, and unnecessary steroid use may mask symptoms of more serious conditions requiring different treatment, as highlighted by the American College of Physicians and the Centers for Disease Control and Prevention 1.
Management Strategies
- Acute uncomplicated rhinosinusitis is a self-limited infection that usually resolves without antibiotics, even in patients with a bacterial cause.
- Most patients diagnosed with acute rhinosinusitis have more adverse effects than benefits from antibiotics.
- A meta-analysis of adults with acute rhinosinusitis showed that the number needed to treat was 18 for 1 patient to be cured rapidly, but the number needed to harm from adverse effects from antibiotics was 8.
- Adjunctive therapy, such as intranasal saline irrigation or intranasal corticosteroids, has been shown to alleviate symptoms and potentially decrease antibiotic use.
From the Research
Effectiveness of Corticosteroids for Upper Respiratory Infections (URI)
- The use of systemic corticosteroids for acute respiratory tract infections (ARTIs), including URIs, is not supported by evidence and guidelines, but it is a common practice 2.
- A study found that 11.8% of patients with an ARTI diagnosis were prescribed systemic steroids, with high geographical variability in the United States 2.
- Another study found no evidence to support the use of corticosteroids for acute lower respiratory tract infection (ALRTI) in patients with clinically unrecognised asthma 3.
- However, corticosteroid therapy has been shown to be effective in adults with acute asthma, accelerating the resolution of symptoms and reducing the risk of relapse 4.
- For URIs, treatment typically focuses on relieving symptoms, and corticosteroids are not usually recommended unless there is an underlying condition such as allergic rhinitis 5, 6.
- Topical corticosteroids, such as steroid nasal sprays, can be effective in managing upper respiratory allergy, but their use should be properly monitored and instructed to minimize adverse effects 6.