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Low Dose Of Steroids – Effective In Treating Sepsis

Low dose of steroids are beneficial in treating sepsis. The latest meta-analysis indicates that steroids are useful but only when started later and delivered in lower doses over a longer period. The analysis also confirmed that a delayed, low-dose five- to seven-day steroid regimen followed by steroid taper for an equal period is effective regardless of response to corticotropin stimulation test. The new meta-analysis was headed by Dr. Peter C. Minneci of the critical care medicine department of the NIH in Bethesda, Maryland.

From Medscape today:

The difficulty with steroid use is that most published articles provide little evidence to back up claims of efficacy. For example, Dr. Minneci said a literature search identified 1,324 articles, of which 162 were clinical trials, but most of those were not randomized.

“Studies published after 1997 consistently report a beneficial effect for steroids. Four studies report a mortality benefit,” Dr. Minneci pointed out.

Analysis indicates several differences in steroid use in the earlier studies compared with the more recent studies. “The newer studies generally enrolled sicker patients — for example, control mortality in the recent studies is 57% while in the earlier studies it was 34%, and 100% of patients in the recent studies are on vasopressors,” Dr. Minneci said.

There are some arguments whether steroids are beneficial to sepsis patients because of the many meta-analyses conducted years ago. However, there are important things that medical experts consider like in the studies published before 1989, steroids were initiated in less than two hours, while in the later trials steroid therapy was started at 23 hours and administered for an average of six days rather than one day, which was the case in the earlier studies. As pointed out by Dr. Minneci, none of the earlier studies used steroid tapers, while all of newer studies used tapers.

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