From the Guidelines
Budesonide should be temporarily withheld in patients with active infections, particularly those caused by Salmonella or Listeria, due to the increased risk of severe infections in individuals receiving immunosuppressive therapy. This recommendation is based on the most recent guidelines from the Journal of Crohn's and Colitis, which suggest that immunosuppressive therapy, including budesonide, should be temporarily withheld until resolution of the active infection 1. The guidelines highlight the risk of more severe infections with Salmonella enteritidis and S. typhimurium, as well as systemic and central neurological infections with Listeria monocytogenes, in patients receiving immunosuppressive agents.
Key considerations for managing patients with active infections while on budesonide include:
- Temporarily withholding immunosuppressive therapy, including budesonide, until resolution of the active infection 1
- Using antibiotics such as fluoroquinolones or third-generation cephalosporins to treat Salmonellosis
- Considering a combination of antibiotics and surgical treatment for complicated infections, such as S. typhimurium osteomyelitis or septic arthritis
- Being aware of the high risk of intestinal or systemic Salmonella spp. infections and L. monocytogenes infection in patients on immunosuppressive therapy
It is essential to individualize the decision to withhold budesonide based on the type and severity of infection, the condition being treated with budesonide, and the patient's overall health status. Patients should not stop budesonide suddenly without consulting their healthcare provider, as abrupt discontinuation can lead to worsening of the underlying condition or withdrawal symptoms if used long-term. The ECCO guidelines on the prevention, diagnosis, and management of infections in inflammatory bowel disease provide a framework for managing patients with active infections while on immunosuppressive therapy, including budesonide 1.
From the FDA Drug Label
Monitor patients for the development of infection and consider discontinuation of budesonide extended-release tablets if the patient develops an infection while on treatment.
- Budesonide should be held if someone has an active infection, as it may exacerbate existing infections or increase the risk of disseminated infections.
- The decision to hold budesonide should be made on a case-by-case basis, considering the severity of the infection and the potential benefits and risks of continuing treatment 2.
From the Research
Infection Risk with Budesonide
- Budesonide is an immunosuppressive medication, and its use can increase the risk of infections, as seen with other immunosuppressive therapies 3, 4.
- The risk of infection with budesonide is particularly concerning in patients with active infections, as it can exacerbate the condition and lead to severe consequences.
- Studies have shown that immunosuppressive medications, including budesonide, can suppress the immune system, making patients more susceptible to infections 5, 6.
Management of Infections with Budesonide
- In patients with active infections, it is crucial to weigh the benefits and risks of continuing budesonide therapy, considering the potential for increased infection risk 4.
- Healthcare professionals should closely monitor patients on budesonide for signs of infection and take appropriate measures to prevent and control infections 7.
- The decision to hold or continue budesonide in patients with active infections should be made on a case-by-case basis, taking into account the individual patient's risk factors and the severity of the infection.
Considerations for Budesonide Use
- Budesonide has been shown to have a comparative suppressive effect to methyl-prednisolone on the gut immune system, which may contribute to its therapeutic effects in inflammatory bowel disease 5.
- However, this immunosuppressive effect also increases the risk of infections, highlighting the need for careful consideration and monitoring when using budesonide in patients with active infections 3, 4.