The role of systemic corticosteroids when treating infections in adult primary care

Abstract

Inflammatory response to aggressive infection is responsible not only for symptoms, especially pain, but also for severity, when the inflammatory cascade is violent, and provokes a deleterious cytokine storm.

Due to their anti-inflammatory properties, corticosteroids are widely used in ambulatory medical practice. While their beneficial effects on some symptoms, particularly pain, are undeniable, so are the risks associated with their other properties (immunosuppression, neurostimulation, hypermetabolism), even during short-term administration at low doses.

Following robust risk–benefit assessment, the role of corticosteroids in the treatment of a number of serious pathologies (septic shock, severe acute community-acquired pneumonia, and some forms of bacterial meningitis such as hypoxia-related pneumocystosis, etc.) is presently well-defined. The objective of this review is not to consider the role of corticosteroids in cases of severe infectious disease necessitating hospital-based management, or in contexts where there exists a clear consensus in favor of their utilization.

This work represents an attempt to apprise the current state of knowledge on the interest of corticosteroids in the management of infections in adults in primary care.

Corticosteroid treatment can be beneficial with regard to some of the infectious diseases treated in primary care. That said, when the benefit actually appears, it remains modest, and the level of evidence supporting the utilization of corticosteroids is low or moderate. In no situation is an indication for corticosteroid therapy official or even, at the very least, indisputable.

With regard to the pathologies under consideration, corticosteroid prescription must imperatively be based on impeccable characterization of the clinical situation, diagnosis of severity, knowledge of the disease field, and risk–benefit assessment for a given patient.