Steroids Uses

• Anti-inflammatory—steroids are often given in high dose for their anti-inflammatory effect, e.g. asthma, allergic and anaphylactoid reactions, vasculitic disorders, rheumatoid arthritis, inflammatory bowel disease, neoplasm-related cerebral oedema, the fibro-proliferative phase of ARDS, pneumococcal meningitis, pneumocystis pneumonia, laryngeal oedema (e.g. after repeated intubation) and after spinal cord injury. Benefit is unproved as yet in cerebral oedema following head injury or cardiorespiratory arrest, and may be harmful in cerebral malaria and sepsis (at high dose).

• A multicentre trial has shown improved outcomes with 'low dose' hydrocortisone (50mg qds for one week) in septic shock patients with depressed adrenal function (subnormal plasma cortisol response to ACTH, often despite 'normal' or raised plasma levels). Some patients with hypotension not responding to catecholamines will improve with corticosteroid therapy.

• Replacement therapy is needed for patients with Addison's disease and after adrenalectomy or pituitary surgery. In the longer term, fludrocortisone is usually required in addition for its mineralocorticoid sodium-retaining effect. Higher replacement doses are needed in chronic steroid takers (i.e. >2 weeks within the last year) undergoing a stress, e.g. surgery, infection.

• Immunosuppressive — after organ transplantation

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