From the FDA Drug Label
Steroids should be used with caution in nonspecific ulcerative colitis, if there is a probability of impending perforation, abscess, or other pyogenic infection, diverticulitis, fresh intestinal anastomoses, active or latent peptic ulcer, renal insufficiency, hypertension, osteoporosis and myasthenia gravis Signs of peritoneal irritation following gastrointestinal perforation in patients receiving large doses of corticosteroids may be minimal or absent.
Dexamethasone (Decadron) is not indicated for the treatment of peritoneal abscess. Caution is advised when using corticosteroids in patients with abscess or other pyogenic infections, as they may mask signs of peritoneal irritation. 1
From the Research
Dexamethasone (Decadron) is not typically recommended as a primary treatment for peritoneal abscesses. The standard treatment for peritoneal abscesses involves drainage of the abscess (either surgically or via percutaneous drainage guided by imaging) combined with appropriate antibiotic therapy targeting the likely causative organisms. Key points to consider in the treatment of peritoneal abscesses include:
- The use of antibiotics that cover gram-negative bacteria, gram-positive bacteria, and anaerobes, such as piperacillin-tazobactam, meropenem, or combinations like ceftriaxone plus metronidazole 2.
- Percutaneous drainage is a highly effective method for treating peritoneal abscesses, with a success rate of 74% for peritoneal abscesses, 67% for retroperitoneal abscesses, and 82% for pelvic abscesses 3.
- Corticosteroids like dexamethasone could potentially be harmful in this setting as they suppress the immune system, which might impair the body's ability to fight the infection and could lead to worsening of the infection or its spread.
- Steroids may mask signs of clinical deterioration by reducing fever and inflammatory markers without addressing the underlying infection. In certain specific circumstances, such as when there is significant inflammatory response causing systemic complications, steroids might be considered as an adjunctive therapy, but this would be determined on a case-by-case basis by the treating physician and is not standard practice for uncomplicated peritoneal abscesses. The most recent and highest quality study available, 3, supports the use of percutaneous catheter drainage of abdominal abscess after abdominal surgery, with a low rate of complication (1%) and a beneficial temporizing effect. Overall, the treatment of peritoneal abscesses should prioritize drainage and antibiotic therapy, with corticosteroids considered only in specific cases where the benefits outweigh the risks.