Corticosteroids intravenous

Oral acyclovir is recommended for the treatment of varicella infection (chickenpox) in patients over 13 years of age who are othei vdse healthy, children over 12 months of age wdth a chronic cutaneous or pulmonary condition or receiving long-term salicylate therapy, and in children receiving short or intermittent courses of aerosolized corticosteroids. Intravenous acyclovir should be used for treatment of varicella infection in immunocompromised children, including those receiving high doses of corticosteroids. Acyclovir has been showm to be the most effective agent for the treatment of infections caused by VZV (Snoeck et al., 1999). 

Nonspecific immunosuppressive therapy in an adult patient is usually through cyclosporin (35), started intravenously at the time of transplantation, and given orally once feeding is tolerated. Typically, methylprednisone is started also at the time of transplantation, then reduced to a maintenance dose. A athioprine (31) may also be used in conjunction with the prednisone to achieve adequate immunosuppression. Whereas the objective of immunosuppression is to protect the transplant, general or excessive immunosuppression may lead to undesirable compHcations, eg, opportunistic infections and potential malignancies. These adverse effects could be avoided if selective immunosuppression could be achieved. Suspected rejection episodes are treated with intravenous corticosteroids. Steroid-resistant rejection may be treated with monoclonal antibodies (78,79) such as Muromonab-CD3, specific for the T3-receptor on human T-ceUs. Alternatively, antithymocyte globulin (ATG) may be used against both B- and T-ceUs. 

Laine-Cessac P, Moshinaly H, Gouello JP. Geshn P, Allain P Severe anaphylactoid reaction after intravenous corticosteroids. Report of a case and review of the literature. Therapie 1990 45 505-508. 

There is no evidence that intravenous corticosteroid administration is more effective than oral administration, and the oral route is preferred in acute severe asthma.3 There are also few data to guide selection of initial corticosteroid doses. Recommended doses for acute severe asthma are shown in Table 11-5, page 227 however, recent data indicate that... 

Patients with severe UC symptoms require hospitalization for management of their disease. If the patient is unresponsive to oral or topical mesalamine and oral corticosteroids, then a course of intravenous corticosteroids should be initiated.1 Hydrocortisone 300 mg/day given in three divided doses or methylprednisolone 60 mg daily for 7 to 10 days are the preferred therapies. 

Infliximab 5 mg/kg is also an option for severe UC. Cyclosporine 2 to 4 mg/kg per day given as a continuous intravenous infusion should be reserved for patients unresponsive to 7 to 10 days of intravenous corticosteroid therapy. 

Most patients with severe to fulminant CD require hospitalization for appropriate treatment. Patients should be assessed for possible surgical intervention if abdominal distention, masses, abscess, or obstruction are present. Intravenous daily doses of corticosteroids equivalent to prednisone 40 to 60 mg are recommended as initial therapy to rapidly suppress severe inflammation. 

Limited evidence indicates that cyclosporine, or possibly tacrolimus, may be effective as salvage therapy for patients who fail intravenous corticosteroid therapy.2 Surgical intervention may ultimately be necessary for medically refractory disease. 

Corticosteroids hasten functional recovery after relapses.27 Intravenous adrenocorticotropic hormone, intravenous methylprednisolone, or oral prednisone are used for treatment of relapses. Generally, intravenous methylprednisolone is considered the drug of choice for acute relapses.28... 

Clinical improvement usually begins during corticosteroid treatment. No standard exists for the administration of an oral prednisone taper after the intravenous methylprednisolone treatment. If a taper is given, it is usually completed over 1 to 2 weeks. 

Corticosteroids play a key role in the management of SVCS, particularly in cases of lymphoma, because these tumors inherently respond to corticosteroid therapy. They are also helpful in the setting of respiratory compromise. Corticosteroids benefit patients who are receiving radiation therapy by reducing local radiation-induced inflammation and increased intracranial pressure. Dexamethasone 4 mg intravenously or by mouth every 6 hours is a frequently used regimen. The dosage should be tapered on completion of radiation therapy or resolution of symptoms. 

Corticosteroids are a mainstay in the management of brain I metastases. They reduce edema that typically surrounds sites of metastasis, thereby reducing ICP. A loading dose of dexam-ethasone 10 mg followed by 4 mg by mouth or intravenously every 6 hours typically is used. Symptom relief may occur shortly after the loading dose, although the maximum benefit may not be seen for several days (after definitive therapy). 

A first open, uncontrolled study [46], performed in 12 patients with active IBD refractory to standard treatment who all had positive stool culture, suggested that adding rifaximin (800 mg daily) could be beneficial. A further small but controlled investigation performed in our unit [47] evaluated the efficacy and systemic absorption of rifaximin in patients with moderately to severely active UC refractory to steroid treatment. Patients were eligible if they had no response to intravenous corticosteroid therapy (methylprednisolone 1 mg/kg/day) after 7-10 days. Twenty-eight patients were randomized to receive rifaximin 400 mg b.i.d. or placebo for 10 days as an add-on... 

Chapman RW, Selby WS, Jewell DP Controlled trial of intravenous metronidazole as adjunct to corticosteroids in severe ulcerative colitis. Gut 1986 27 1210-1212. 

Mantzaris GJ, Hatzis A, Kontogiannis P, Triadaphyllou G Intravenous tobramycin and metronidazole as an adjunct to corticosteroids in acute, severe ulcerative colitis. Am J Gastroenterol 1994 89 43-46. 

Idiopathic thrombocytopenic purpura is an immune-mediated disease in which immunoglobulin, either as antibody directed against platelet antigens or nonspecifically bound to platelets, is present in increased quantities on platelets. This leads to increased destruction of platelets and, in many instances, megakaryocytes. Standard treatment consists of corticosteroids and splenectomy (72). When these measures fail, treatment may include androgenic steroids, administration of intravenous 7-globulin, or injection of vinca alkaloids. 

Its most important adverse effects are nephrotoxicity and ototoxicity. The risks for nephrotoxicity can be limited by adequate hydration. Marked nausea and vomiting are frequent. Only mild-to-moderate myelosuppression is seen. Pseudo-allergic reactions may occur which respond to intravenous epinephrine and corticosteroids or antihistamines. 

It is usual to give a sedating antihistamine, for example chlorphenamine 10 mg by intramuscular or slow intravenous injection, because of the relatively short half-life of epinephrine (adrenaline), and because of the active role of histamine in anaphylaxis. In addition, the inflammatory reaction can be moderated by the administration of a corticosteroid, such as hydrocortisone 200 mg by intramuscular or slow intravenous injection. Corticosteroids may take several hours to act, but can be of some help in so-called biphasic anaphylactic reactions. 

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