Steroids and antibiotics prescribed together: the new trend?

Question: Dear Dr. Roach, in late spring of 2016, I had a sinus infection and was prescribed both an antibiotic and prednisone. I was told that the steroid would increase the effectiveness of the antibiotic. After reading the patient insert for prednisone, I chose to take only the antibiotic, with excellent results.

Prednisone from $0.37

Since then, three of my friends were also prescribed antibiotics by three different doctors for various conditions. All were also prescribed prednisone to take with. Two of them did take prednisone, resulting in side effects.

This week I went to another doctor, was diagnosed with an acute nasopharyngitis and was told to take an antibiotic and prednisone. When I told him that I didn’t want to take prednisone, the doctor informed me that he NEVER prescribes antibiotics without prednisone.

I was prescribed clindamycin and methylprednisolone. I chose not to take the steroid again.

Can you tell me whether this dual prescription is a widespread medical trend or just a local one? Is there really a good reason for prescribing antibiotics and prednisone together, and am I being foolish not to follow the doctor’s orders?

Response: There have been two recent systematic reviews on the use of oral steroids, such as prednisone or methylprednisolone, in combination with antibiotics in the treatment of acute sinusitis. These studies have shown a faster recovery in those who take the combination of steroids and antibiotics than in those who take antibiotics alone, and I suspect that is why your doctors, and those of their friends, have been prescribing them.

However, there is a downside to steroids, as you note. It is not just the unpleasant immediate side effects, such as nervousness and difficulty sleeping. Steroids can have serious side effects in the short term (confusion and even psychosis are well known). In the long term, the list of possible side effects is very long, so the benefit should always be weighed against possible harm.

This is particularly the case in people at high risk of side effects, such as diabetics (in whom sugar levels routinely rise when taking steroids) or those with high blood pressure (which often exacerbated by steroid use).

Personally, I prefer to use nasal steroids in combination with antibiotics. They have many of the benefits of oral steroids with few of the side effects. Nasal steroids don’t work as fast as oral steroids, however.

Dr. Roach regrets not being able to respond to individual letters, but will incorporate them into the column whenever possible.