From the Guidelines
Oral or injectable corticosteroids should not be used in the outpatient treatment of influenza, as they are not recommended by clinical practice guidelines due to the lack of benefit and potential harm.
Key Points
- The Infectious Diseases Society of America (IDSA) recommends against the use of corticosteroid adjunctive therapy for the treatment of adults or children with suspected or confirmed seasonal influenza, unless clinically indicated for other reasons 1.
- The use of corticosteroids in adults with influenza is also suggested against by the Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM), with a conditional recommendation and very low quality of evidence 1.
- The IDSA guidelines emphasize the importance of early treatment with antivirals, which can reduce the duration of symptoms and risk of complications, and may decrease mortality among high-risk populations 1.
- Annual vaccination is considered the best method for preventing or mitigating the impact of influenza, and chemoprophylaxis with antiviral medications can be used in certain situations 1.
Rationale
The guidelines are based on a systematic review of the evidence and consider the care of children, pregnant and postpartum women, and nonpregnant adults, including special populations such as immunocompromised patients 1. The IDSA panel followed a process that included a systematic weighting of the strength of recommendations and quality of evidence, using the US Public Health Service Grading System 1.
From the Research
Role of Corticosteroids in Outpatient Treatment of Influenza
- The use of corticosteroids in patients with influenza has been associated with significantly higher mortality and higher incidence of nosocomial infection 2, 3, 4, 5, 6
- Studies have shown that corticosteroid therapy is likely to increase overall mortality, and this trend is consistent regardless of the quality and sample size of the studies 3, 4, 5, 6
- The administration of corticosteroids may be associated with higher incidence of hospital-acquired pneumonia and longer duration of mechanical ventilation and ICU stay 3, 4, 5
- The evidence suggests that routine steroid use may not be ideal for influenza virus infection, and its current use in severe influenza pneumonia should be restricted to very selected cases and in the setting of clinical trials 3, 4, 5, 6
- The certainty of the available evidence from observational studies is very low, with confounding by indication a major potential concern, and more high-quality research is needed to determine the effectiveness of corticosteroids for people with influenza 5, 6
Key Findings
- A systematic review and meta-analysis found that corticosteroid treatment was significantly associated with mortality and nosocomial infection in patients with influenza virus infection 4
- A Cochrane review found that adjunctive corticosteroid therapy was associated with increased mortality, but the result should be interpreted with caution due to the low quality of the evidence 5, 6
- The use of corticosteroids in patients with COVID-19 has shown a good body of evidence of benefit in terms of mortality, but the evidence for influenza is not as clear 2