For years, high doses of corticosteroids have been recommended for the treatment of septic shock, a condition which leads to heart, kidney and respiratory failure in a high proportion of patients. The idea was based on animal experiments where corticosteroids improve survival when given before shock 1 or shortly afterwards.(2)
It has been pointed out, however, that "...extrapolation of data from experimental models of shock to the clinical setting may be dangerous and misleading.”(3) So it is not surprising that an analysis of clinical trials by the Drug & Therapeutics Bulletin found that “high-dose corticosteroids are ineffective for the prevention or treatment of shock associated with sepsis. They do not improve outcome, and make secondary infection worse. They may harm patients with impaired renal (kidney) function.”(1) For instance, one trial found that corticosteroids not only failed to prevent or reverse shock but actually seemed to increase deaths amongst patients, even though treatment was initiated within 2 hours.(4)
I ) Drug & Therapeutics Bulletin, 1990, vol.28, 74-75.
2) S.G.Hershey in Anaesthesiology: Proceedings of the Vl World Congress of Anaesthesiology, Mexico City, April 1976, Eds. E.Hulsz et al (Excerpta Medica, 1977).
3) A.S.Nies in Clinical Pharrnacology: Basic Principles in Therapeutics, Eds. K.L.Melmon & H.F.Morrelli (MacMillan,1978)
4) R.C.Bone et al, New England Journal of Medicine, 1987, September 10, 653-658.
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