RSS-Feed abonnieren
DOI: 10.1055/a-1302-3530
Steroide in der Infektionsmedizin
Steroids in infection medicine![](https://www.thieme-connect.de/media/dmw/202103/lookinside/thumbnails/dmw-13023530_10-1055-a-1302-3530-1.jpg)
Was ist neu?
Steroide sollen bei der Sepsis/septischen Schock, der Tuberkulose und der Meningtitis weiterhin nur in bestimmten Fällen zum Einsatz kommen: Nämlich bei anders nicht stabilisierbarem Kreislaufversagen in der Sepsis, bei tuberkulöser Meningitis oder bei eitriger Meningitis durch Pneumokokken.
Der Einsatz von Steroiden bei eher später, hyperinflammatorischer Covid-19-Erkrankung kann die Sterblichkeit wesentlich senken, wobei die Effekte vor allem für sauerstoffpflichtige und intubiert beatmete Patienten signifikant sind, während Steroide bei Patienten ohne Sauerstoffpflichtigkeit keine signifikant mortalitätssenkende Effekte haben. Untersucht sind Dexamethason, Methylprednisolon und Hydrocortison, wobei die Evidenzlage für Dexamethason am besten ist.
Steroide kommen weiterhin beim Immunrekonstitutionssyndrom (IRIS) des erworbenen Immunschwächesyndroms (AIDS) durch HIV zum Einsatz.
Abstract
Corticosteroids have been found as useful adjunctive therapy in patients with various infections and hyperinflammation-associated disease. They are recommended in practice guidelines for patients with tuberculous and pneumococcal meningitis and patients with immune reconstitution syndrome associated with antiretroviral therapy. A new indication is severe COVID-19. Evidence from clinical trials is insufficient to allow the routine use of steroids among patients with septic shock, community-acquired pneumonia or tuberculous pericarditis.
Publikationsverlauf
Artikel online veröffentlicht:
29. Januar 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 McGee S, Hirschmann J. Use of corticosteroids in treating infectious diseases. Arch Intern Med 2008; 168: 1034-1046
- 2 Lansbury L, Rodrigo C, Leonardi-Bee J. et al Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database Syst Rev 2019; 2: CD010406
- 3 Zhou Y, Fu X, Liu X. et al Use of corticosteroids in influenza-associated acute respiratory distress syndrome and severe pneumonia: a systemic review and meta-analysis. Sci Rep 2020; 10: 3044
- 4 Stern A, Skalsky K, Avni T. et al Corticosteroids for pneumonia. Cochrane Database Syst Rev 2017; 12: CD007720
- 5 Brunkhorst FM, Weigand MA, Pletz M. et al S3-Leitlinie Sepsis – Prävention, Diagnose, Therapie und Nachsorge. Med Klin Intensivmed Notfmed 2020; 115 (Suppl. 02) 37-109 . Sepsis-LL 2013
- 6 Venkatesh B, Finfer S, Cohen J. et al Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med 2018; 378: 797-808
- 7 Annane D, Renault A, Brun-Buisson C. et al Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med 2018; 378: 809-818
- 8 Antcliffe DB, Burnham KL, Al-Beidh F. et al Transcriptomic signatures in sepsis and a differential response to steroids. From the VANISH randomized trial. Am J Respir Crit Care Med 2019; 199: 980-986
- 9 Schaberg T, Bauer T, Brinkmann F. et al S2k-Leitlinie: Tuberkulose im Erwachsenenalter. Pneumologie 2017; 71: 325-397
- 10 Wiysonge CS, Ntsekhe M, Thabane L. et al Interventions for treating tuberculous pericarditis. Cochrane Database Syst Rev 2017; 9: CD000526
- 11 George IA, Thomas B, Sadhu JS. Systematic review and meta-analysis of adjunctive corticosteroids in the treatment of tuberculous pericarditis. Int J Tuberc Lung Dis 2018; 22: 551-556
- 12 Wilkinson RJ, Rohlwink U, Misra UK. et al Tuberculous meningitis. Nat Rev Neurol 2017; 13: 581-598
- 13 Tai M-LS, Nor HM, Kadir KAA. et al Paradoxical manifestation is common in HIV-negative tuberculous meningitis. Medicine 2016; 95: e1997
- 14 Schutz C, Davis AG, Sossen B. et al Corticosteroids as an adjunct to tuberculosis therapy. Expert Rev Respir Med 2018; 12: 881-891
- 15 Prasad K, Singh MB, Ryan H. Corticosteroids for managing tuberculous meningitis. Cochrane Database Syst Rev 2016; 4: CD002244
- 16 Brouwer MC, McIntyre P, Prasad K. et al Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2015; 9: CD004405
- 17 Rayanakorn A, Ser HL, Pusparajah P. et al Comparative efficacy of antibiotic(s) alone or in combination of corticosteroids in adults with acute bacterial meningitis: a systematic review and network meta-analysis. PLoS One 2020; 15: e0232947
- 18 Pfister H, Bühler R, Eiffert H. et al Ambulant erworbene bakterielle Meningoeinzephalitis. Leitlinien für Diagnostik und Therapie in der Neurologie der DGN 2016. AWMF-Registernummer 030/089 https://dgn.org/wp-content/uploads/2015/10/030-089l_S2k_Ambulant_erworbene_Meningoenzephalitis_2016-08-verlaengert_01.pdf
- 19 Meyding-Lamadé U, Jacobi C, Martinez-Torres F. et al The German trial on aciclovir and corticosteroids in Herpes simplex virus-encephalitis (GACHE): a multicenter, randomized, double-blind, placebo-controlled trial. Neurol Res Pract 2019; 1: 26
- 20 Simjian T, Muskens IS, Lamba N. et al Dexamethasone administration and mortality in patients with brain abscess: a systematic review and meta-analysis. World Neurosurg 2018; 115: 257-263
- 21 Nau R, Behnke-Mursch J, Eiffert H. et al Hirnabszess. Leitlinien für Diagnostik und Therapie in der Neurologie der DGN 2016. AWMF-Registernummer 030/108. https://dgn.org/wp-content/uploads/2013/01/LL_35_Hirnabszess.pdf
- 22 Leisman DE, Ronner L, Pinotti R. et al Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes. Lancet Respir Med 2020; 8: 1233-1244
- 23 Felsenstein S, Herbert JA, McNamara PS. et al COVID-19: immunology and treatment options. Clin Immunol 2020; 215: 108448
- 24 Horby P, Lim WS, Emberson JR. RECOVERY Collaborative Group. et al Dexamethasone in hospitalized patients with Covid-19 – preliminary report. N Engl J Med 2020; DOI: NEJMoa2021436. . Online ahead of print
- 25 Sterne JAC, Murthy S, Diaz JV. WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. et al Administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis. JAMA 2020; 324: 1330-1341
- 26 Sarkar S, Khanna P, Soni KD. Are the steroids a blanket solution for COVID-19? A systematic review and meta-analysis. J Med Virol 2020; 10: eD000142
- 27 van Paassen J, Vos JS, Hoekstra EM. et al Corticosteroid use in COVID-19 patients: a systematic review and meta-analysis on clinical outcomes. Crit Care 2020; 24: 696
- 28 Guerrier G, Lefèvre P, Chouvin C. et al Jarisch-Herxheimer Reaction Among Patients with Leptospirosis: Incidence and Risk Factors. Am J Trop Med Hyg 2017; 96: 791-794
- 29 Butler T. The Jarisch-Herxheimer reaction after antibiotic treatment of spirochetal infections: a review of recent cases and our understanding of pathogenesis. Am J Trop Med Hyg 2017; 96: 46-52
- 30 Diagnostik und Therapie der Syphilis. Aktualisierung S2k 2020. AWMF-Registernummer 059/002. Im Internet (letzter Zugriff: 15.12.2020): https://www.awmf.org/uploads/tx_szleitlinien/059-002l_S2k_Diagnostik_Therapie_Syphilis_2020_06_1_01.pdf
- 31 Robertson J, Meier M, Wall J. et al Immune reconstitution syndrome in HIV: validating a case definition and identifying clinical predictors in persons initiating antiretroviral therapy. Clin Infect Dis 2006; 42: 1639-1646
- 32 Müller M, Wandel S, Colebunders R. et al Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. Lancet Infect Dis 2010; 10: 251-261
- 33 Meintjes G, Stek C, Blumenthal L. et al Prednisone for the prevention of paradoxical tuberculosis-associated IRIS. N Engl J Med 2018; 379: 1915-1925