Study links short-course oral steroids to severe adverse effects in children

Results from a recent study showed that use of a single oral corticosteroid 'burst' was associated with an increased incidence of GI bleeding, sepsis and pneumonia within the first 30 days after initiation of therapy.

Use of short-burst oral corticosteroids in children was associated with a two-fold increase in the risk of sepsis. | GETTY IMAGES
Use of short-burst oral corticosteroids in children was associated with a two-fold increase in the risk of sepsis. | GETTY IMAGES

Short-term courses (≤14 days) of oral corticosteroids are often prescribed to combat acute respiratory tract infections or allergic conditions in children. While the adverse effect profile associated with long-term use of oral corticosteroids is well established, less is known about the effects of using these oral corticosteroid 'bursts', particularly in children.

Study design

Using data from the Taiwanese National Health Insurance Research Database, the researchers conducted a population-based cohort study (n=1,064,587) to evaluate the association of a single corticosteroid burst in children (<18 years) with four severe adverse events: GI bleeding, sepsis, pneumonia, and glaucoma.

The risks of each adverse event within the pre-treatment (reference) period (defined as 5 to 90 days prior to initiation of a corticosteroid burst) were compared with the risks in each of two post-treatment periods (5-30 days [first period] and 31-90 days [second period] after initiation of a burst).

Significant risk increase

The researchers observed that corticosteroid bursts were significantly associated with a 1.4- to 2.2-fold increase of GI bleeding, sepsis and pneumonia, but not glaucoma, within the first month after initiation of treatment, with the risk attenuating during the subsequent 31-90 days.

The incidence rate ratios (IRRs) for GI bleeding and pneumonia across the two post-treatment periods were significantly higher than the reference period (1.41 and 2.19, respectively, in the first period and 1.10 and 1.09, respectively, in the second period).

The IRR for sepsis in the first post-treatment period was significantly greater than the reference period, but not in the second post-treatment period (2.02 and 1.08, respectively). The IRR for glaucoma was not significantly greater than the reference period in either post-treatment period (0.98 and 0.95 in the first and second periods, respectively).

The researchers state that their study demonstrates the potential harms of prescribing corticosteroid bursts for children and calls for the prudent use of such treatment.

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