Adjuvant therapies in critical care: steroids to treat infectious diseases
Globally, clinicians have avoided prescribing corticosteroids (CS) for active infection, as they have immunosuppressive effects and therefore may impair mechanisms that fight infection. However, we, as intensivists, often see patients adequately treated with antibiotics deteriorating on the basis of progressive, localized or systemic inflammation triggered by an infection that is being treated with an adequate antibiotic regimen. Clinically, they have been proven as deleterious in some infectious diseases, such as influenza pneumonia, established for early use in a wide range of infective conditions, such as pneumococcal meningitis, and remain a matter of intense debate in several other infectious conditions, such as severe community-acquired pneumonia.
We present a synthesis of the role of corticosteroids in severe infectious situations treated in intensive care departments, discussing, as the title implies, infectious diseases and not syndromic presentations, such as...
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Conflicts of interest
José Manuel Pereira: received honoraria for lectures from MSD, Astellas, Pfizer and Novartis. Thiago Lisboa: no conflicts of interest. José Artur Paiva: no conflicts of interest.
- 12.Pastores SM, Annane D, Rochwerg B, The Corticosteroid Guideline Task Force of SCCM and ESICM (2017) Guidelines for the diagnosis of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Med. https://doi.org/10.1007/s00134-017-4951-5 CrossRefPubMedGoogle Scholar