Prescribing systemic steroids for acute respiratory tract infections in United States outpatient settings: A nationwide population-based cohort study

Abstract

Background Evidence and guidelines do not support use of systemic steroids for acute respiratory tract infections (ARTIs), but such practice appears common. We aim to quantify such use and determine its predictors. Methods and findings We conducted a cohort study based on a large United States national commercial claims database, the IBM MarketScan, to identify patients aged 18-64 years with an ARTI diagnosis (acute bronchitis, sinusitis, pharyngitis, otitis media, allergic rhinitis, influenza, pneumonia, and unspecified upper respiratory infections) recorded in ambulatory visits from 2007 to 2016. We excluded those with systemic steroid use in the prior year and an extensive list of steroid-indicated conditions, including asthma, chronic obstructive pulmonary disease, and various autoimmune diseases. We calculated the proportion receiving systemic steroids within 7 days of the ARTI diagnosis and determined its significant predictors. We identified 9,763,710 patients with an eligible ARTI encounter (mean age 39.6, female 56.0%) and found 11.8% were prescribed systemic steroids (46.1% parenteral, 47.3% oral, 6.6% both). All ARTI diagnoses but influenza predicted receiving systemic steroids. There was high geographical variability: the adjusted odds ratio (aOR) of receiving parenteral steroids was 14.48 (95% confidence interval [CI] 14.23-14.72, p < 0.001) comparing southern versus northeastern US. The corresponding aOR was 1.68 (95% CI 1.66-1.69, p < 0.001) for oral steroids. Other positive predictors for prescribing included emergency department (ED) or urgent care settings (versus regular office), otolaryngologist/ED doctors (versus primary care), fewer comorbidities, and older patient age. There was an increasing trend from 2007 to 2016 (aOR 1.93 [95% CI 1.91-1.95] comparing 2016 to 2007, p < 0.001). Our findings are

Burden of Respiratory Infection and Tuberculosis Among US States from 1990 to 2019

“…A distinct gender difference was found in that males had a lower RIT age-standardized incidence rate (except tuberculosis), but severer outcomes as a higher age-standardized death and DALY rate, which accorded with many previous studies concerning respiratory infection disease. 16 For instance, the ratio of male to female was 1:1.27 in a US nationwide population-based acute respiratory infection study involving 9,763,710 outpatients, 17 but the male-to-female ratio of tuberculosis was 1.88:1 in 1999. 18 Moreover, the hazard ratio of mortality for males was 1.33 in active tuberculosis 19 and 1.59 in COVID-19.…”

Síndrome de lisis tumoral secundario a la administración de corticoides en una adolescente sin enfermedad neoplásica confirmada: reporte de un caso

“…Fuera de las enfermedades oncológicas, los corticoides se indican en una miríada de enfermedades agudas o crónicas, y sus efectos secundarios son proporcionales a la duración y a la dosis prescripta. 5 En pediatría es frecuente su uso fuera de las recomendaciones. En este sentido, es necesario revisar las indicaciones de uso de corticosteroides sistémicos para las infecciones respiratorias agudas (IRA) y los problemas de seguridad asociados.…”

“…Los corticoides sistémicos como tratamiento de la insuficiencia renal aguda carecen de evidencia fuerte, sin embargo, su uso continúa en aumento. 5 El tratamiento indicado en otra institución con antibióticos y corticoides por un cuadro de disnea y tos de 20 días de evolución debe llamarnos a la reflexión a los pediatras. Las IRA se encuentran entre las enfermedades agudas más comunes en pediatría.…”

“…2 Los corticoides son un factor d e s e n c a d e n a n t e p a r a S L T 3 , 4 y , a d e m á s , suelen utilizarse en infecciones respiratorias sin justificación clara. 5 Se debe realizar una evaluación integral de los pacientes durante la consulta clínica y realizar indicaciones adecuadas de medicamentos. En este reporte describimos la evolución tórpida de una paciente con SLT secundaria a la administración de corticoides.…”

Advances in community-acquired pneumonia

“…A series of meta-analyses based on small trials with significant flaws has led to a significant increase in interest in corticosteroids in CAP, 34,35 with evidence of large scale overuse of these potentially toxic agents. 36 A more detailed discussion of the primary papers used by the meta-analyses has been published. 37 Of significance, Torres et al 38 used an entry criteria of a C-reactive protein greater than 150 mg/dL, but found no difference in mortality or length of hospital stay in 120 patients.…”