Can deflazacort be given during a common cold?

Can Deflazacort Be Given During a Common Cold?

No, deflazacort should not be given for the common cold—corticosteroids, including deflazacort, provide no symptomatic benefit for common cold symptoms and significantly increase the risk of serious infections, including potentially fatal complications. 1, 2

Why Corticosteroids Are Not Indicated

• No clinical benefit: High-quality evidence (Level 1a) from the European Position Paper on Rhinosinusitis demonstrates that corticosteroids do not provide symptomatic relief for the common cold 1
• Multiple randomized controlled trials show no improvement in duration or severity of cold symptoms with intranasal corticosteroids 3, 4
• The common cold is a self-limiting viral illness requiring only symptomatic management—not immunosuppressive therapy 1, 5

Specific Risks of Deflazacort During Viral Infections

Deflazacort suppresses the immune system and dramatically increases infection risk, which is particularly dangerous during an active viral illness like the common cold 2:

• Corticosteroids reduce resistance to new infections and can exacerbate existing viral infections 2
• They mask signs of infection, potentially allowing complications to progress undetected 2
• Viral infections (including common cold viruses) can have serious or fatal courses in corticosteroid-treated patients 2
• The rate of infectious complications increases with corticosteroid dosage 2

Specific Viral Infection Concerns

• Varicella and measles can have serious or even fatal courses in patients taking corticosteroids like deflazacort 2
• Corticosteroid use during viral infections increases risk of disseminated infections and reactivation of latent infections 2
• The FDA label explicitly warns about increased infection risk with any pathogen during deflazacort therapy 2

What Should Be Used Instead

For symptomatic relief of common cold, use combination antihistamine-decongestant-analgesic products, which provide significant relief in 1 out of 4 patients 5:

• First-generation antihistamine (brompheniramine) with sustained-release pseudoephedrine for congestion and rhinorrhea 5
• NSAIDs (ibuprofen 400-800 mg every 6-8 hours) for headache, malaise, and pain 5, 6
• Zinc lozenges (≥75 mg/day) only if started within 24 hours of symptom onset 5, 6
• Nasal saline irrigation for symptom relief 5

Critical Clinical Pitfall

Never confuse the indication for deflazacort (Duchenne muscular dystrophy) with symptomatic treatment of intercurrent infections 2:

• Deflazacort is FDA-approved specifically for Duchenne muscular dystrophy, not respiratory infections 2
• Even in patients already taking deflazacort for DMD, the drug does not treat cold symptoms—only manage the underlying muscle disease 2
• Patients on chronic deflazacort who develop infections may require dose reduction or withdrawal 2

When to Suspect Bacterial Complications

Only consider any intervention beyond symptomatic care if at least 3 of these 5 criteria are present 7:

• Discolored (purulent) nasal discharge
• Severe local facial pain
• Fever >38°C (100.4°F)
• "Double sickening" (improvement followed by worsening)
• Elevated inflammatory markers

Even then, systemic corticosteroids are not recommended—the EPOS guidelines advise against systemic corticosteroids for post-viral rhinosinusitis based on lack of benefit and potential harm 1

Bottom Line for Clinical Practice

• The common cold requires no corticosteroid therapy whatsoever 1
• Deflazacort specifically increases infection risk and provides no benefit for cold symptoms 2, 3
• Use evidence-based symptomatic treatments: combination antihistamine-decongestant-analgesics, NSAIDs, and supportive care 5, 6
• Reserve antibiotics only for confirmed bacterial complications, not routine cold symptoms 1