Steroid prescribing practices for mildly symptomatic and asymptomatic COVID-19 patients, among doctors of selected Sri Lankan hospitals

Abstract

Introduction: Effects of infection by SARS-COV-2 virus (COVID-19) range from asymptomatic infection to respiratory failure with multi-organ dysfunction. Steroids are indicated in patients with severe pneumonia, who require oxygen supplementation. There is evidence of harm if steroids are given for asymptomatic or mildly symptomatic patients.Objectives: This study assesses the steroid prescribing practices among Sri Lankan doctors for mildly symptomatic and asymptomatic COVID-19 patients.Methodology: This clinical survey was conducted during 20/11/2021 to 15/03/2022 using an electronic questionnaire, sent to doctors in 16 hospitals, representing all provinces of Sri Lanka. Doctors who have not treated nor advised patients with COVID-19 were excluded.Results: Hundred and thirty-five participants were incorporated into the study. The mean age was 33.7 years (SD=7.82). The majority did not prescribe steroids routinely for asymptomatic (n=132, 97.8%) and mildly symptomatic (n=124, 91.9%) COVID-19. Dexamethasone was the most prescribed steroid. Doctors who treated COVID-19 patients in the private sector were more likely to prescribe steroids for mild symptoms (p=0.016). The majority (n=101, 81.5%) identified a decrease of oxygen saturation to below 94% on room air as an indication to start steroids.Conclusions: Most of the study participants adhered to the recommended guidelines and refrained from prescribing steroids in mildly symptomatic and asymptomatic COVID-19 patients.