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DOI: 10.1055/a-1302-3530
Steroide in der Infektionsmedizin
Steroids in infection medicine
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.
Publication History
Article published online:
29 January 2021
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