Rational use of corticosteroid treatment in the early phase of severe COVID-19

Corticosteroid in COVID-19


  • Ranistha Ratanarat Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, 10700
  • Anutr Thitayanapong Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, 10700




COVID-19, SARS-CoV-2, Corticosteroid, Critical ill, Immunomodulator


Mechanisms of hypoxemia in COVID-19 pneumonia include pulmonary inflammation, alveolar collapse, atelectasis, and pulmonary intravascular coagulopathy due to a hyperinflammatory response to SARS-CoV-2 infection. Systemic corticosteroids are widely applied as a standard treatment for hospitalized COVID-19 patients after several studies have shown favorable outcomes. However, the standard dosing and tailoring of corticosteroids in COVID-19 patients have not been established. Differences in dosing and timing of corticosteroid use may affect the outcome of COVID-19 patients. Inappropriate use of corticosteroids can lead to less benefit and potentially harmful adverse events. Dexamethasone is the most widely used corticosteroid as a result of the  positive outcome from the RECOVERY study and its high anti-inflammatory potency. Although several studies have shown the benefit of higher dose corticosteroids in severe COVID-19 patients, serious adverse events associated with the use of corticosteroids, such as superimposed bacterial and/or fungal infections, have also been observed. Therefore, in this article, we reviewed current evidence of corticosteroid usage in COVID-19 patients and suggested a strategy for tailoring corticosteroid usage according to the clinical severity and risk of the patients.


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How to Cite

Ratanarat R, Thitayanapong A. Rational use of corticosteroid treatment in the early phase of severe COVID-19: Corticosteroid in COVID-19. Clin Crit Care [Internet]. 2023 Jun. 26 [cited 2024 Jun. 20];31(1):2023:e0010. Available from: https://he02.tci-thaijo.org/index.php/ccc/article/view/259411



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