Steroids and antibiotics prescribed together: the new trend?

Question: Dear Dr. Roach, in the late spring of 2016, I had an infection in the sinuses and prescribed antibiotics and prednisone. I was told the steroid would increase the effectiveness of the antibiotic. After reading the patient’s insertion for prednisone, I chose to take only the antibiotic, with excellent results.

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 took prednisone, resulting in side effects.

This week I went to another doctor, diagnosed with an acute nasopharyngitis and was told to take an antibiotic and prednisone. When I told him that I did not want to take prednisone, the doctor informed me that he NEVER prescribed 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 an extensive medical trend or just a local one? Is there really a good reason to prescribe 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 their doctors, and those of their friends, have prescribed them.

However, there is a disadvantage 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 run, the list of possible side effects is very long, so the benefit should always be weighed against possible harm.

This is particularly true in people at high risk of side effects, such as diabetics (where sugar levels routinely rise when taking steroids) or those with high blood pressure (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 do not 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. Readers can email questions to [email protected]