From the Guidelines
The use of glucocorticoids in treating influenza is not recommended due to the potential for increased mortality and secondary infections, as suggested by a systematic review of observational studies 1. The evidence from various studies indicates that glucocorticoids may not be beneficial in treating influenza and may even be harmful. A systematic review of observational studies found that corticosteroid therapy was associated with superinfection and increased mortality in influenza patients 1. Another study found that glucocorticoid treatment in influenza pneumonia was associated with significant risks, including higher mortality, more secondary bacterial infections, and increased length of ICU stay 1. The Infectious Diseases Society of America (IDSA) guidelines also recommend against the routine use of adjunctive steroids in patients treated for community-acquired pneumonia (CAP), which includes influenza 1.
Some studies suggest that glucocorticoids may be beneficial in specific situations, such as in patients with severe COVID-19 or acute respiratory distress syndrome (ARDS) 1. However, these findings are not directly applicable to influenza treatment. The potential benefits of glucocorticoids in reducing inflammation and preventing cytokine storms must be weighed against the potential risks, including increased mortality and secondary infections.
In general, the use of glucocorticoids in treating influenza is not recommended, and antiviral medications like oseltamivir should be used as the primary treatment. Patients with underlying respiratory conditions like asthma or COPD who already use inhaled corticosteroids should continue their regular regimen during influenza infection. It is essential to consider the potential risks and benefits of glucocorticoids in each individual patient and to use them judiciously, if at all.
Key points to consider:
- Glucocorticoids may not be beneficial in treating influenza and may even be harmful.
- The IDSA guidelines recommend against the routine use of adjunctive steroids in patients treated for CAP.
- Glucocorticoids may be beneficial in specific situations, such as in patients with severe COVID-19 or ARDS.
- Antiviral medications like oseltamivir should be used as the primary treatment for influenza.
- Patients with underlying respiratory conditions should continue their regular regimen during influenza infection.
From the Research
Role of Glucocorticoids in Treating Influenza
- The use of glucocorticoids (corticosteroids) in treating influenza is not recommended in the absence of another indication, as it has been associated with increased mortality 2.
- There is no evidence to support the use of glucocorticoids as a treatment for influenza, and their use is not mentioned in the context of influenza treatment in the provided studies 3, 4, 5, 6.
- The treatment of influenza typically involves early antiviral therapy and supportive care, with oseltamivir being the first choice for antiviral treatment 3, 2, 5, 6.
- Other treatment options, such as zanamivir, may be considered in certain cases, but glucocorticoids are not recommended as a treatment for influenza 2, 4, 5, 6.
Alternative Treatment Options
- Oseltamivir and zanamivir are effective in reducing body temperature and relieving influenza-like symptoms in patients with COPD 4.
- Neuraminidase inhibitors, such as oseltamivir and zanamivir, can decrease the median duration of influenza-related symptoms by approximately 1 day if initiated within 48 hours of the onset of symptoms 5.
- Antiviral therapy can serve as an important adjunct to vaccination in controlling the impact of influenza, but its use is typically recommended for high-risk individuals such as those over 65 years or under 2 years, and individuals with chronic cardiovascular, pulmonary or renal disease, diabetes mellitus or immunosuppression 6.