Role of Corticosteroids in Dengue Fever
Corticosteroids are not recommended for the routine management of dengue fever as there is insufficient evidence to support their use and they may potentially cause harm. 1, 2, 3
Evidence Against Corticosteroid Use in Dengue
Multiple systematic reviews have found no significant benefit of corticosteroids in reducing mortality, need for blood transfusion, or serious complications in dengue shock syndrome 2, 3
A Cochrane review analyzing four trials with 284 participants found that corticosteroids were no more effective than placebo or no treatment for reducing deaths (RR 0.68,95% CI 0.42 to 1.11) 2
There is insufficient evidence to justify the use of corticosteroids in managing dengue shock syndrome, and they may potentially cause harm 2
Studies evaluating corticosteroids in early dengue infection (without shock) found no evidence of benefit for preventing progression to severe disease 3
Limitations of Current Evidence
The quality of evidence regarding corticosteroid use in dengue is rated as low to very low 3
Most trials are more than 20 years old with several methodological limitations 3
A double-blind evaluation found that hydrocortisone hemisuccinate (50 mg/kg) showed virtually identical outcomes compared to placebo in terms of mortality, duration of shock, and fluid requirements 4
Potential Risks of Corticosteroid Use
Corticosteroids can potentially cause harm through various adverse effects, including 5:
- Hyperglycemia
- Secondary infections
- Gastrointestinal bleeding
- Psychiatric effects
- Electrolyte disturbances
The Society of Critical Care Medicine recommends against the use of corticosteroids in major trauma (which shares some pathophysiological features with severe dengue) due to lack of mortality benefit 6
Current Management Approach for Dengue
The mainstay of dengue management remains careful monitoring and judicious administration of fluids 1
There is currently no specific treatment or vaccine widely available for dengue 1
The pathophysiological basis for severe dengue involves vascular endothelial dysfunction induced by cytokine and chemical mediators 1
Special Considerations
Some non-randomized trials have suggested possible benefit of corticosteroids as rescue medication for severe shock, but the evidence base is small and good-quality trials are lacking 1
The effectiveness of corticosteroids may depend on sustained therapeutic blood levels and using steroids with higher receptor affinity, but further clinical trials using standardized protocols are needed 7
If corticosteroids must be used in specific circumstances, infection surveillance is particularly important as they can blunt the febrile response 5
In conclusion, while the theoretical immunomodulatory effects of corticosteroids might seem beneficial in dengue fever, the current evidence does not support their routine use. Well-designed randomized controlled trials are still needed to definitively establish their role in dengue management.