Corticosteroids may mask some signs of infection, and new infections
may appear during their use. Infections with any pathogen including
viral, bacterial, fungal, protozoan or helminthic infections, in any
location of the body, may be associated with the use of
corticosteroids alone or in combination with other immunosuppressive
agents that affect cellular immunity, humoral immunity, or neutrophil
function.1
These infections may be mild, but can be severe and at times fatal.
With increasing doses of corticosteroids, the rate of occurrence of
infectious complications increases.2 There may be decreased resistance
and inability to localize infection when corticosteroids are used.
Prolonged use of corticosteroids may produce posterior subcapsular
cataracts, glaucoma with possible damage to the optic nerves, and may
enhance the establishment of secondary ocular infections due to fungi
or viruses.
Average and large doses of hydrocortisone or cortisone can cause
elevation of blood pressure, salt and water retention, and increased
excretion of potassium. These effects are less likely to occur with
the synthetic derivatives except when used in large doses. Dietary
salt restriction and potassium supplementation may be necessary. All
corticosteroids increase calcium excretion.
Administration of live or live, attenuated vaccines is contraindicated
in patients receiving immunosuppressive doses of corticosteroids.
Killed or inactivated vaccines may be administered to patients
receiving immunosuppressive doses of corticosteroids; however, the
response to such vaccines may be diminished. Indicated immunization
procedures may be undertaken in patients receiving
nonimmunosuppressive doses of corticosteroids.
Persons who are on drugs which suppress the immune system are more
susceptible to infections than healthy individuals. Chicken pox and
measles, for example, can have a more serious or even fatal course in
non-immune children or adults on corticosteroids. In such children or
adults who have not had these diseases, particular care should be
taken to avoid exposure. How the dose, route and duration of
corticosteroid administration affects the risk of developing a
disseminated infection is not known. The contribution of the
underlying disease and/or prior corticosteroid treatment to the risk
is also not known. If exposed to chicken pox, prophylaxis with
varicella zoster immune globulin (VZIG) may be indicated. If exposed
to measles, prophylaxis with pooled intramuscular immunoglobulin (IG)
may be indicated. (See the respective monographs for complete VZIG and
IG prescribing information.) If chicken pox develops, treatment with
antiviral agents may be considered. Similarly, corticosteroids should
be used with great care in patients with known or suspected
Strongyloides (threadworm) infestation. In such patients,
corticosteroids-induced immunosuppression may lead to Strongyloides
hyperinfection and dissemination with wide-spread larval migration,
often accompanied by severe enterocolitis and potentially fatal
gram-negative septicemia.
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