Steroid Immunosuppression

Steroids should be considered standard of care and immediately started in cases that meet hospital admission criteria, usually Severe COVID Pneumonitis. There is body of evidence to support its use in cases showing early ARDS, septic shock and confers mortality benefit. What: Dexamethasone 6mg PO/IV once daily (with STAT dose); or Prednisolone 40mg PO once daily; or Hydrocortisone 50mg IV three times daily. Administration: Oral (PO) is the preferred route, intravenous (IV) only when preferred route is not available. Duration: 10 days.

Cautions

Already using long-term steroids?

Where patients are already on steroids (usually prednisolone) it is reasonable to convert to dexamethasone, but remember to return back to maintenance dose after 10 days.

Hyperglycemia

Steroid induced raised blood sugars are a consequence of high dose steroid use. It does not imply diabetes, although diabetic patients are at greater risk of elevated blood sugar measurement. It is crucial to monitor and manage excessive blood sugar concentrations. Each trust has developed guidelines for Hyperglycemia in COVID Steroid administration, please refer to you own trust guidelines for more information.