Adverse Reactions Common with Short-Course Oral Corticosteroids in Kids

By Rita Buckley

NEW YORK - Vomiting, behavioral changes and sleep disturbances are the most common adverse reactions to short-course corticosteroids in children, while increased susceptibility to infection is the most serious, according to a new systematic review.

The review, online January 14 in the Archives of Disease in Childhood, included 38 studies, 22 of which were randomized controlled trials.

Dr. Sharon Conroy and colleagues from the University of Nottingham Royal Derby Hospital Center in the U.K. found 850 adverse drug reactions among 3,200 children who received short-course corticosteroid treatment; the children were between 28 days and 18 years old.

The three most frequent reactions were vomiting (5.4%), changes in behavior (4.7%), and sleep disturbances (4.3%). "Vomiting was the most common reason for discontinuing steroids," the authors note.

Other adverse effects included increased blood pressure in 144 of 369 (39%) patients, and weight gain in 21 of 75 (28%). Forty-three of 53 of tested children (81%) showed biochemical hypothalamic-pituitary-adrenal axis suppression.

Meta-analysis of three randomized controlled trials found statistically significant biochemical hypothalamic-pituitary-adrenal suppression associated with oral corticosteroids compared with inhaled ones.

Infection due to the immunosuppressant action of corticosteroids was one of the most serious adverse drug reactions, affecting up to 1% of patients. One child died after contracting varicella zoster.

Dr. Conroy said doctors have been aware of most of these side effects for many years, but have not had a good indication of their frequency of occurrence.

"These findings should be useful to pediatricians and pharmacists in counseling patients and families when a child is prescribed an oral corticosteroid," she told Reuters Health by email.

Dr. Carl Baum from Pediatric Emergency Medicine at Yale School of Medicine in New Haven, Connecticut, who was not involved in the study, said it "is important because it examines adverse reactions from a class of drugs that we prescribe very frequently for asthma and croup in the Pediatric Emergency Department."

Dr. Baum, who was not involved in the review, said corticosteroids are extremely valuable in relieving symptoms of these diseases and often help prevent admission to the hospital.

"Timely administration of steroids in asthma can even prevent significant morbidity and death," he told Reuters Health by email.

Dr. Rachel Robinson from the division of allergy and immunology at the Ann and Robert H. Lurie Children's Hospital of Chicago said at times the use of corticosteroids can't be avoided.

However, she told Reuters Health by email, clinicians should carefully weigh the risks and benefits of treatment on a case-by-case basis.

"These findings are an important reminder that systemic corticosteroids are far from harmless," she said, noting that they should be used sparingly for a limited number of conditions and only when absolutely necessary.

One example, said Dr. Robinson, would be asthma flares that are not well-controlled with other medications or do not respond to first-line therapies, such as albuterol.

Dr. Conroy and her co-authors declared no conflicts of interest.

SOURCE: bit.ly/1PJDjNl

Arch Dis Child 2016.

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