Dexamethasone Dose Is too Low
Our experience in 120 inpatients with COVID-19 was that in about one in every 10 patients, the cortisone dose of 6 mg dexamethasone is not sufficient to prevent the hyperinflammation from escalating into increasing respiratory failure, need for intubation, and then often a fatal outcome. Wherever we observed in patients with rising C-reactive protein (CRP) in the absence of confirmed bacterial or fungal infection a deterioration of the respiratory situation we treated this group of patients with a short intensive course of high-dose steroids (on three consecutive days 150 mg methylprednisolone each, in some cases 250 mg methylprednisolone daily, then treatment cessation without tapering down). Since we have been using this therapeutic approach we have had to intubate and ventilate only two patients, who died shortly after and were not able to receive cortisone because of chronic obstructive pulmonary disease (COPD) with bacterial superinfection. In all others we were able to prevent intubation. We did not observe adverse effects such as more cases of bacterial or fungal infections. Our patients’ mean age was quite high, at 75 years, as several nursing homes near our site had been affected by COVID-19 outbreaks.
It is a shame that the current clinical practice guideline for the inpatient treatment of patients with COVID-19 did not make any mention of high-dose intensive steroid treatment.
Dr. med. Jörg-Heiner Möller
Asklepios Krankenhaus im Städtedreieck
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Kluge S, Janssens U, Spinner CD, Pfeifer M, Marx G, Karagiannidis C: Clinical practice guideline: Recommendations on in-hospital treatment of patients with COVID-19. Dtsch Arztebl Int 2021; 118: 1–7 VOLLTEXT|