Steroids in infection: an old wives’ tale
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* Vinay Prasad

In their otherwise informative vignette about a 48-year-old woman presenting with headache, red eyes, blurred vision and hearing loss, Chan and colleagues perpetuate a common medical myth.1 They caution that, “systemic steroids should not be administered before an underlying infection, which could be the cause of this clinical presentation, has been excluded.”

Unfortunately, there is a dearth of evidence supporting this claim, and at least one good study, which reaches the opposite conclusion. McGee and Hirschmann reviewed published randomized double-blind trials of steroids in infection and concluded that steroids are beneficial and safe for a wide variety of infections.2 They noted that, for bacterial meningitis, steroids likely improve outcomes. Steroids were associated with worse outcomes for only two types of infections: viral hepatitis and cerebral malaria.

Dogged adherence to the old wives’ tale about steroids and infection continues to create the potential to delay safe and effective treatment.

## References

1.  Chan EW, Sanjay S, Chang BC. Headache, red eyes, blurred vision and hearing loss. CMAJ 2010; 182:1205–9.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTgyLzExLzEyMDUiO3M6NDoiYXRvbSI7czoyMToiL2NtYWovMTgzLzEvODMuMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  McGee S, Hirschmann J. Use of corticosteroids in treating infectious diseases. Arch Intern Med 2008; 168:1034–46.
    
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    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=18504331&link_type=MED&atom=%2Fcmaj%2F183%2F1%2F83.2.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000256057000004&link_type=ISI)