From the Guidelines
Corticosteroids should not be used to treat influenza.
Rationale
- The use of corticosteroids in adults with influenza is not recommended due to the low quality of evidence supporting their effectiveness 1.
- The Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) suggest against the use of corticosteroids in adults with influenza, citing a conditional recommendation with very low quality of evidence 1.
- This guideline is focused on critically ill patients, but the principle of avoiding corticosteroids in influenza treatment can be applied to the general population, prioritizing caution in real-life clinical medicine.
- The exact mechanism of corticosteroids in influenza is not well understood, but their use may be associated with increased risk of adverse effects, such as secondary infections or delayed recovery 1.
From the Research
Role of Corticosteroids in Treating Influenza
- The use of oral or injectable corticosteroids in treating influenza is a topic of controversy, with some studies suggesting that they may be associated with increased mortality and nosocomial infection 2, 3, 4.
- A systematic review and meta-analysis found that corticosteroid treatment was significantly associated with mortality and nosocomial infection in patients with influenza virus infection 3.
- Another study found that corticosteroid treatment was associated with higher incidence of hospital-acquired pneumonia and longer duration of mechanical ventilation and ICU stay 2.
- However, a recent retrospective analysis suggested that sequential treatment with high-dose steroids and short-course oral glucocorticoids may be helpful in reducing the tracheal intubation rate and mortality rate in patients with severe influenza virus-associated pneumonia 5.
- The use of corticosteroids in patients with influenza has been associated with significantly higher mortality and higher incidence of nosocomial infection, while in patients with COVID-19, there is a good body of evidence of the benefit of corticosteroids in terms of mortality 6.
Potential Benefits and Harms
- The potential benefits of corticosteroids in treating influenza include reducing the tracheal intubation rate and mortality rate in patients with severe influenza virus-associated pneumonia 5.
- However, the potential harms of corticosteroids in treating influenza include increased mortality, nosocomial infection, and longer duration of mechanical ventilation and ICU stay 2, 3, 4.
- The use of corticosteroids in patients with influenza should be restricted to very selected cases and in the setting of clinical trials 2.
Current Recommendations
- The current recommendations for the use of corticosteroids in treating influenza are limited, and further research is required to determine their role in the treatment of this condition 2, 3, 4.
- The 2019 IDSA/ATS guidelines recommend the use of corticosteroids in patients with septic shock refractory to vasopressors and fluid resuscitation, but do not provide specific guidance on their use in patients with influenza 6.