Thursday, March 24, 2016

Long term high dose steroids - Prevention of complications

Today, my staff asked - What are the conditions you can do prophylaxis against in a patient with long term steroids?

Guess before you read the answers!

1. Stress ulcers: Use proton pump inhibitors.
Concomitant gastric protection is necessary in patients on long-term, high-dose steroids or taking concomitant non-steroid anti-inflammatory drugs. [1]

2. Osteoporosis: Give them calcium supplements, bisphosphonates, parathyroid hormone.
The newer therapies zoledronic acid and teriparatide are now recommended along with alendronate and risedronate for the treatment of Glucocorticoid Induced Osteoporosis. [2]

3. I couldn't find any guidelines for PCP (pneumocystis jiroveci) prophylaxis but something to think about?

That's all!

Quote for the day: No one is you and that is your power :)


[1] Steroid ulcers: Any news?
Mario Guslandi World J Gastrointest Pharmacol Ther. doi:  10.4292/wjgpt.v4.i3.39
[2] American College of Rheumatology 2010 Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis
Jennifer M Grossman, Rebecca Gordon, et-al DOI 10.1002/acr.20295


  1. Knowing that PCP typically occurs in HIV-infected patients with a CD4 count <200 cells/microL who are not receiving potent antiretroviral therapy or appropriate prophylaxis, we use cotrimoxazole (sulfamethoxazole-trimethoprim) for prophylaxis against PCP.
    This paper "Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda." showed that "daily co-trimoxazole prophylaxis was associated with reduced morbidity and mortality and had beneficial effects on CD4-cell count and viral load. Co-trimoxazole prophylaxis is a readily available, effective intervention for people with HIV infection in Africa."

    Sorry I don't really know how to quote properly.. but hi, IkaN! :)

    1. Oh yes PCP prophylaxis is done for HIV. But I was looking for an answer in relationship to corticosteroids.

      Oh it's fine, love. Hello! :)


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