Corticosteroid Stewardship

Systemic corticosteroids (S-CS) have a significant role in Urgent Care medicine, primarily in use of significant infectious and immune-mediated conditions.  It is imperative to establish appropriate S-CS prescribing practices amongst clinicians while simultaneously being supported by organizational guidelines and algorithmsThough ultimately, responsible use of S-CS is a clinicians responsibility, prescribers are urged to review risks of use, as well as the potential for misuse and overuse, with patients at each visit where appropriate and should be documented in the medical record(It is noted, that expansive use of inhaled and topical corticosteroids can lead to systemic effects, these notes will primarily address parenteral and oral uses. These recommendations are also geared toward immunocompetent adult patients). 

In particular asthma presents specific challenges to both patients and Urgent Care providers alike.  Recommendations for S-CS stewardship in asthmatic conditions are being encouraged by the major asthma and allergy foundations.  This particular subset of patients are at a higher risk of exposure to S-CS and remaining up to date on treatment guidelines is a must. More information can be found here: Asthma & Allergy Foundation of America.

Oral Corticosteroids

Pills spilling out of a prescription bottle with a safety cap, onto a reflective surface.

Risk of OCS use, all patients

Patients at an increased risk of the above effects include extremes of age (pediatric and geriatric populations), those  with conditions already noted in the indirect risk column, like diabetes and osteoporosis, and any patient with metabolic conditions that can increase the bioavailability of the steroid (CKD, CLD, endocrine disorders).  

There is no one algorithm for appropriate use of S-CS. Each condition in which S-CS are considered require individualized review of evidence based best practices and patient risks.  The bottom line, before prescribing a S-CS for a patient, consider if there are other more appropriate options.