Subgroup analyses for causative organisms showed that corticosteroids reduced mortality in Streptococcus pneumoniae ( S. pneumoniae ) meningitis ( RR , 95% CI to ), but not in Haemophilus influenzae ( H. influenzae ) or Neisseria meningitidis ( N. meningitidis ) meningitis. Corticosteroids reduced severe hearing loss in children with H. influenzae meningitis ( RR , 95% CI to ) but not in children with meningitis due to non- Haemophilus species.
Since the introduction of systemic corticosteroids, clinical dermatologists have learned to modify a vast array of skin diseases by using the potent antiinflammatory and immunosuppressive properties of this class of drugs. However, glucocorticoids have proven to be the “archetypal double-edged sword of medicine.” 28 Their potential to cause multiple adverse side effects presents the dermatologist with difficult decisions on the management of patients with potentially steroid-responsive disorders. The possible beneficial effects of systemic glucocorticoids must be weighed against risk factors including their probability of occurrence and their degree of harm. In general, the risk of adverse effects of corticosteroids increases with duration of therapy and frequency of administration. Side effects such as gastrointestinal intolerance, mood changes, nervousness, and insomnia can occur with short courses of corticosteroids.
Because of these side effects, doctors frequently choose safer medications, such as the 5-ASA drugs and antibiotics, as initial therapy. But there are a number of ways to reduce the risk of developing side effects. These include rapid but careful tapering off of steroids; alternate-day dosing; rectally applied corticosteroids; and rapidly metabolized corticosteroids such as budesonide (described above). To help prevent osteoporosis, many doctors routinely prescribe calcium supplements as well as multivitamins that contain vitamin D. Another option is the use of bisphosphonates, such as risedronate (Actonel®) and alendronate (Fosamax®). These compounds, which have been shown to help avert bone loss, are effective in treating and preventing steroid-induced osteoporosis.