How the dose, route and duration of corticosteroid administration affects the risk of developing a disseminated infection is not known. In such children or adults who have not had these diseases, particular care should be taken to avoid exposure. Chicken pox and measles, for example, can have a more serious or even fatal course in non-immune children or adults on corticosteroids. Persons who are on drugs which suppress the immune system are more susceptible to infections than healthy individuals. During prolonged corticosteroid therapy, these patients should receive chemoprophylaxis. If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary as reactivation of the disease may occur. The use of hydrocortisone tablets in active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate antituberculous regimen. Indicated immunization procedures may be undertaken in patients receiving nonimmunosuppressive 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. All corticosteroids increase calcium excretion.Īdministration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. Dietary salt restriction and potassium supplementation may be necessary. These effects are less likely to occur with the synthetic derivatives except when used in large doses. Infants born of mothers who have received substantial doses of corticosteroids during pregnancy, should be carefully observed for signs of hypoadrenalism.Ĭorticosteroids have been shown to impair fertility in male rats.Īverage and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. Usage in pregnancy: Since adequate human reproduction studies have not been done with corticosteroids, the use of these drugs in pregnancy, nursing mothers or women of childbearing potential requires that the possible benefits of the drug be weighed against the potential hazards to the mother and embryo or fetus. 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. 2 There may be decreased resistance and inability to localize infection when corticosteroids are used. With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases. These infections may be mild, but can be severe and at times fatal. 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. In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during, and after the stressful situation is indicated.Ĭorticosteroids may mask some signs of infection, and new infections may appear during their use.
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