Dosing should be individualized based on disease and patient response:
Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses
Maintenance dose: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.
Uses: As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
We included 25 studies involving 4121 participants (2511 children and 1517 adults; 93 mixed population). Four studies were of high quality with no risk of bias, 14 of medium quality and seven of low quality, indicating a moderate risk of bias for the total analysis. Nine studies were performed in low-income countries and 16 in high-income were associated with a non-significant reduction in mortality (% versus %; risk ratio (RR) , 95% confidence interval (CI) to , P value = ). A similar non-significant reduction in mortality was observed in adults receiving corticosteroids (RR , 95% CI to , P value = ). Corticosteroids were associated with lower rates of severe hearing loss (RR , 95% CI to ), any hearing loss (RR , 95% CI to ) and neurological sequelae (RR , 95% CI to ).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) orNeisseria 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 high-income countries, corticosteroids reduced severe hearing loss (RR , 95% CI to ), any hearing loss (RR , 95% CI to ) and short-term neurological sequelae (RR , 95% CI to ). There was no beneficial effect of corticosteroid therapy in low-income analysis for study quality showed no effect of corticosteroids on severe hearing loss in high-quality treatment was associated with an increase in recurrent fever (RR , 95% CI to ), but not with other adverse events.