From the Guidelines
For upper respiratory infections, steroids are not typically recommended as they do not provide significant benefits for viral infections and may suppress the immune system. When considering the use of corticosteroids, it's crucial to weigh the potential benefits against the risks, especially in the context of upper respiratory infections (URIs) which are often viral in nature. The evidence from 1 suggests that corticosteroids may be considered in specific cases such as hospitalized patients with community-acquired pneumonia (CAP) at a dose less than 400 mg IV hydrocortisone or equivalent for 5−7 days 1. However, this does not directly apply to the general treatment of upper respiratory infections. Key points to consider in the management of URIs include:
- The cause of the infection, with most being viral and not requiring specific antiviral treatment
- The severity of symptoms, which can guide the need for supportive care
- The potential for secondary bacterial infections, which may require antibiotic treatment
- The importance of supportive care measures such as rest, hydration, and the use of over-the-counter medications for symptom relief. In the absence of specific indications such as severe allergic reactions or certain inflammatory conditions, the use of steroids like prednisone at doses of 20-60mg daily for 5-7 days is not standard treatment for routine URIs. Instead, focusing on supportive care and monitoring for signs of complications or secondary infections is generally recommended. If symptoms are severe, last longer than expected, or are accompanied by high fever or difficulty breathing, consulting a healthcare provider is advisable to determine the best course of treatment 1.
From the Research
Upper Respiratory Infection and Steroid Use
- The provided studies do not directly address the optimal dose of steroids for treating upper respiratory infections 2, 3, 4, 5, 6.
- However, one study suggests that systemic steroid use in acute respiratory tract infections is common, but its clinical net benefit is unclear 3.
- Another study found that inhaled corticosteroids may increase the risk of upper respiratory tract infections in patients with chronic obstructive pulmonary disease, particularly with short-term use of high-dose fluticasone 6.
- The studies primarily focus on the use of antimicrobial therapy and inhaled corticosteroids for various respiratory conditions, but do not provide specific guidance on steroid dosing for upper respiratory infections 2, 4, 5.
Key Findings
- Systemic steroid use is common in acute respiratory tract infections, but its benefits and risks are unclear 3.
- Inhaled corticosteroids may increase the risk of upper respiratory tract infections in patients with COPD, particularly with short-term use of high-dose fluticasone 6.
- Antimicrobial therapy is a common treatment approach for upper respiratory tract infections, with short-course therapy being a potential alternative to traditional longer therapies 2, 5.
Limitations
- The provided studies do not directly address the optimal dose of steroids for treating upper respiratory infections.
- The studies have varying focuses, including antimicrobial therapy, inhaled corticosteroids, and systemic steroid use, making it challenging to draw conclusions about steroid dosing for upper respiratory infections 2, 3, 4, 5, 6.