Risk for infection following oral corticosteroid use in children with asthma♦ 44

Abstract

To assess if one course of oral steroids increases the risk for bacterial infection in children with asthma, we used New York Medicaid data for children 2-15 yo with asthma. We made cohorts of oral steroid users and non-users, and determined the percentage of children in each cohort with antibiotic prescriptions filled in the 30 days after index dates. Index dates were dates oral steroids were started (for steroid users) or matched dates (for steroid non-users). Analyses adjusted for age, month of index date, and recent antibiotic use. Among children who did not receive antibiotics on their index dates, antibiotic prescriptions were filled in the next 30 days for 438 (20%) of 2,145 steroid non-users and 130 (19%) of 698 steroid users (p=NS); compared to non-users, oral steroid users had an adjusted odds ratio of subsequent antibiotic use of 0.92 (95% CI 0.73, 1.15). Among children who received antibiotics on their index dates, antibiotic prescriptions were filled in the next 30 days for 116 (26%) of 451 steroid non-users and 50 (19%) of 260 steroid users (p=0.05); compared to non-users, oral steroid users had an adjusted odds ratio of subsequent antibiotic use of 0.65 (95% CI 0.44, 0.97). Among children with asthma, one course of oral steroids is not associated with an increased use of antibiotics in the 30 days after the course is initiated, suggesting it does not increase the risk for bacterial infections. Compared to asthmatic children given antibiotics without oral steroids, asthmatic children given antibiotics when oral steroids are started have a lower rate of antibiotic use in the next 30 days, probably because of differences in the infections initially treated.