IV Steroids in Sepsis still a thing?

A 47 year old male presents to the ED from home after he was found locked in his attic. He was lethargic and unresponsive. A neighbor had not seen the patient for a few days.  The last time the neighbor saw the patient, he was told by them they weren’t feeling good, and they were going to “netflix and chill”.

Which of the following is true?

A. In adults with septic shock unresponsive to fluid therapy, IV glucocorticoids have been shown to substantially reduce mortality.

B. IV steroids should be given prior to antibiotics in those with suspected meningococcemia.

C. Steroid taper is preferred for those discharged after COPD exacerbation

D. Steroids in pediatric meningitis have been shown to reduce neurologic complications

E. The risk of adverse effects for steroids does not appear to be significant if therapy is <30 days

References:

American Academy of Pediatrics. Pneumococcal infections. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. P.626.

Annane D, Bellissant E, Bollaert PE, et al. Corticosteroids for treating sepsis. Cochrane Database Syst Rev 2015; :CD002243.

Annane D, Bellissant E, Bollaert PE, et al. Corticosteroids in the treatment of severe sepsis and septic shock in adults: a systematic review. JAMA 2009; 301:2362.

Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2015; :CD004405.

Chaudhuri A. Adjunctive dexamethasone treatment in acute bacterial meningitis. Lancet Neurol 2004; 3:54.

de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347:1549.

Minneci PC, Deans KJ, Eichacker PQ, Natanson C. The effects of steroids during sepsis depend on dose and severity of illness: an updated meta-analysis. Clin Microbiol Infect 2009; 15:308.

Minneci PC, Deans KJ, Natanson C. Corticosteroid therapy for severe sepsis and septic shock. JAMA 2009; 302:1643; author reply 1644.

Minneci PC, Deans KJ, Natanson C. Corticosteroid therapy for severe sepsis and septic shock. JAMA 2009; 302:1643; author reply 1644.

Mithoowani S, Gregory-Miller K, Goy J, et al. High-dose dexamethasone compared with prednisone for previously untreated primary immune thrombocytopenia: a systematic review and meta-analysis. Lancet Haematol 2016; 3:e489.

Mizutani H, Furubayashi T, Imai Y, et al. Mechanisms of corticosteroid action in immune thrombocytopenic purpura (ITP): experimental studies using ITP-prone mice, (NZW x BXSB) F1. Blood 1992; 79:942.

Sligl WI, Milner DA Jr, Sundar S, et al. Safety and efficacy of corticosteroids for the treatment of septic shock: A systematic review and meta-analysis. Clin Infect Dis 2009; 49:93.

Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39:1267.

Blake Briggs