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Covid-19 Primary Care Resources

Guidance on steroid prescribing

There is still concern that steroids can increase the risk from Covid-19

This information is sourced from the British Society for Rheumatology (BSR) briefing templateBSR Guidance and the Society for Endocrinology:

Key points on steroid prescribing during the pandemic:

  • Don’t stop current steroids but taper their dose if it is clinically safe to do so
  • Think before starting steroids in the current pandemic
  • Use the lowest possible dose of oral steroids for the shortest period of time
  • Starting oral prednisolone at more than 5mg per day for more than a month could move a patient into the shielding group
  • Starting oral prednisolone at more than 20mg per day (or greater than 0.5mg/kg/day for children) for more than a month will move a patient into the shielding group

Patients with adrenal insufficiency who have suspected Covid‑19:

  • May have atypical presentations (eg no fever, no CRP rise)
  • Should not suddenly stop steroids
  • Need larger than usual steroid doses and slightly different sick day rules; for any patient who has been taking 5mg prednisolone or more for four weeks or longer; Patients on 5-15 mg prednisolone daily should take 10 mg prednisolone every 12 hours. Patients on oral prednisolone >15 mg should continue their usual dose but take it split into two equal doses of at least 10 mg every 12 hours

Should I still be injecting corticosteroids during the current Covid-19 pandemic?

  • Injections must not be undertaken in individuals with active infections
  • In the current situation, the potential therefore arises to do harm to those who may be incubating or later develop Covid-19
  • Only give a steroid injection if a patient has significant disease activity and/or intrusive and persisting symptoms, and there are no appropriate alternatives

See also: Rheumatology patients