Lesson of the Week: Near fatal chickenpox during prednisolone treatment

Rice, Peter A.; Simmons, Kathryn; Carr, Robert; Banatvala, J. E.

doi:10.1136/bmj.309.6961.1069

Cited by 36 publications

(15 citation statements)

References 15 publications

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“…Steroid treatment is the commonest cause of osteoporosis and accounted for more than half the osteoporosis identified in young people in one study 2. Over 5.5 million prescriptions for systemic corticosteroids were issued by general practitioners in the United Kingdom in 1993,3 but no information exists on how these were prescribed. We carried out a community survey in Nottinghamshire to determine the prevalence of continuous use of oral steroids, the conditions for which they were prescribed, and the concurrent use of treatment to prevent osteoporosis.…”

Section: Introductionmentioning

confidence: 99%

Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study

Walsh

Wong²,

Pringle³

et al. 1996

BMJ

338

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Objective-To determine the prevalence of continuous use of oral steroids in the general population, the conditions for which they are prescribed, and the extent to which patients taking oral steroids are taking treatment to prevent osteoporosis.Design-A cross sectional study with a four year retrospective review of drug treatment.Setting-Eight large general practices in central and southern Nottinghamshire.Subjects-A population of 65 786 patients (52% women) registered with a general practitioner during 1995.Results-303 patients (65% (197) women) aged 12-94 years were currently taking "continuous" (for at least three months) oral corticosteroid treatment. This figure represents 0.5% of the total population and 1.4% (245/17 114) of patients aged 55 years or more (1.7% (16619601) of women). The usual steroid was prednisolone (97% (294/303)), the mean dose was 8.0 mg/day, and the median duration of oral steroid treatment determined in 149 patients was three years. The most common conditions for which continuous oral steroids were prescribed were rheumatoid arthritis (23% (70)), polymyalgia rheumatica (22% (66)), and asthma or chronic obstructive airways disease (190%o (59)). Only 41 (14%) of the 303 patients taking oral steroids had received treatment for the prevention of osteoporosis over the past four years. Although 37 ofthe 41 patients were women, only 10% (181181) of the women over 45 years taking continuous oral corticosteroids were currently taking hormone replacement therapy.Conclusions-If our figures are typical then they suggest that over 250 000 people in the United Kingdom are taking continuous oral steroids and that most of these are taking no prophylaxis against osteoporosis.

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Section: Introductionmentioning

confidence: 99%

Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study

Walsh

Wong²,

Pringle³

et al. 1996

BMJ

338

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“…Although most of the survey patients who had previously been treated with steroids carried a steroid card, only half could recall of their doctor's advice on side effects. Even though the true prevalence of immunity to varicella in patients who are uncertain of previous chickenpox infection may be high,2 there is a clear risk for those who do not have antibodies to varicella 1 2. The universal omission of advice regarding exposure to chickenpox in those patients within the present survey who had no recall of having had chickenpox reinforces the need for written instructions regarding potential severe adverse reactions with steroids 3 4…”

Section: Commentmentioning

confidence: 82%

“…Recent reports of severe chickenpox associated with steroid treatment1 2 have highlighted a potential need to amend the current steroid card. In May 1994 the Chief Medical Officer wrote to all doctors in the United Kingdom regarding the hazards of exposure to chickenpox 3.…”

mentioning

confidence: 99%

History of chickenpox and steroid cards: a new warning?

Fehér

Simms

Lant

1996

BMJ

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“…Similar measures have been proposed in those at high risk of sepsis after splenectomy and in those at risk of varicella infection while taking corticosteroids 1 3. The patient should be educated in the same way as patients who have had a splenectomy or who have a dysfunctional spleen 1.…”

Section: Commentmentioning

confidence: 97%