Antibiotic + corticosteroid?

Neuro Guy NP, DNP, PhD, APRN · Mar 12, 2011

Hi manchmal, you ear infection must be bacterial in order for your prescriber to have given you the antibiotic. The rationale behind prescribing an antibiotic along with a corticosteroid is so that the antibiotic can attack the bacterial cell wall, and depending on the precise mechanism by which the antibiotic works, it may cause the bacteria to become swell and lyse/break open.

The corticosteroid, as you mentioned will fight the inflammatory process and decrease the pain associated with that inflammation by inhibiting prostaglandins and other chemical mediators. The immune response is suppressed in that cells that respond to tissue damage (which occurs in inflammation) such as neutrophils and lymphocytes are stopped from infiltrating to the area of infection so that they do not continue to cause inflammation. It is in that way that the immune system is suppressed.

At the end of the infectious process, your body will still have antibodies to the particular strain of microbe that caused your infection and will have B cells that will be able to mount a response to that organism. Remember that in most cases (generally speaking), medicines help your body fight infection, not completely take control.

(Remember, though, that people who don't "have" an immune system due to immunocompromised status, the drugs are pretty much their only defense).

Hope that helped.

Let us now if I made that clear as mud.

Neuro Guy NP, DNP, PhD, APRN · Mar 12, 2011

P.S. I said your infection must have been bacterial, because recall that viruses have no cell wall to attack, which is how antibiotics work. The have only the envelope, and some other miscellaneous parts, which is colds have to run their course.

JE

island40 · Mar 12, 2011

I thought your answer was great!!

K.L.C MSN, RN-BC

manchmal · Mar 12, 2011

Thanks a bunch -- this is starting to make some sense to me! Your explanation makes a lot of sense.

I'm still a little confused about why corticosteroids increase a patient's risk for infection -- I get that they suppress the usual immune response related to inflammation, but they must compromise the other responses, too? In that case, I figure you're giving them because the response itself is more of a problem for the patient than the original "offender" -- so especially in hypersensitivity responses, that makes sense. But are you in a way knocking out some of that usual antibody response when you give a pt. a corticosteroid?

And what the heck does it do to your WBC?

leslie :-D · Mar 12, 2011

But are you in a way knocking out some of that usual antibody response when you give a pt. a corticosteroid?
And what the heck does it do to your WBC?

corticosteroids can mask s/s of infection, by suppressing the inflammatory response, and so, suppresses release of wbcs.

an infection can spread and turn severe just like *that*, yet the wbcs wouldn't respond as expected.

steroids are scary stuff. :twocents:

leslie

NPinWCH · Mar 12, 2011

Well I’d try not to give steroids for bacterial infections, but will if the pain is severe per the patient’s complaint. Since they are good at rapidly suppressing inflammation by inhibiting prostaglandins and leukotrienes they do a great job with inflammation and pain and the studies show they decrease pain significantly within 5 hours.

Your question though is more on about the drug’s suppression of the immune response. It affects the body in several ways. They inhibit cytokines which reduces T cell production and they also actually induce the death of immature T cells in the thymus and in circulation. They can also suppress humoral immunity, which is the problem you are worried about since that’s how we create antibodies. It is true that corticosteroids decrease the number B cells, which in turn decreases the synthesis of antibodies. They also decrease the number of T lymphocytes in circulation and the number of active macrophages, but all of these effects take some time. So, they're usually only seen in those that use the medication for a longer period of time.

I’ll give a steroid if it’s needed, but I don’t always think the risk is worth it and with women adding a steroid to antibiotics really increases the risk of yeast overgrowth, which SUCKS!

As far as the WBC count goes you can initially see some leukocytosis, which sounds counter-intuitive, then after some time you see the expected leukopenia. If you think about it it makes some sense though. Initially, it takes some time for the decreased cell production to kick in, so that isn't a factor at first. BUT remember they decrease the effect of inflammation quickly and the body has already mobilized a bunch of WBCs to fight the infection/cause inflammation. Now we are blocking these cells from doing their job. That means they are left wandering around in circulation instead of being used at the infected site.

Neuro Guy NP, DNP, PhD, APRN · Mar 12, 2011

Well,manchmal, the patient is at risk for infection, among other reason mentioned by another poster, when you have a broad spectrum antibiotic, you are an increased risk for developing another infection of a different kind because you are eliminating all sorts of bacteria including the good kind that act as buffers that create a hostile environment to harmful microbes.

Often times fungal infections result when you use broad spectrum antibiotics. Normal bacterial flora are allowed to overgrow and soon you become overrun by an otherwise normal bacterium species. Example of this would be oral candidiasis post anti-strep throat antibiotics.

ObtundedRN, BSN, RN · Mar 13, 2011

Look up "Demargination" this will answer your question as to why you will see a small rise in WBCs when you first start a steroid.

jasn · Mar 13, 2011

This thread is so helpful :)

I am still confused as to when a patient would be ordered an antibiotic + corticosteroid, versus just an antibiotic (which is what I have typically seen). Is it when the patient's inflammation and pain is severe, more than something like ibuprofen can control (as i know ibuprofen only controls prostaglandin pathway, while corticosteroids controls leukotrienes as well)? Or are there other factors that must be present?

NPinWCH · Mar 13, 2011

This thread is so helpful :)
I am still confused as to when a patient would be ordered an antibiotic + corticosteroid, versus just an antibiotic (which is what I have typically seen). Is it when the patient's inflammation and pain is severe, more than something like ibuprofen can control (as i know ibuprofen only controls prostaglandin pathway, while corticosteroids controls leukotrienes as well)? Or are there other factors that must be present?

Most of the time for routine outpatient infections such as strep throat, otitis media and sinusitis the steroid is give as a comfort measure. I dont usually offer them unless there is a significant reason or intense pain. For example, I'd consider the steroid if a patient had sinusitis or otitis media and was going to be traveling in the next few days, especially by air and my sister's NP gave her a short burst of steroids when she had strep just before her wedding.

It's not something I do routinely, but it has it's place. It's really just a judgment call, unless there is significant inflammation that could potentially obstruct the airway. I do know some practitioners who prescribe them with antibiotics for most adults with the complaints I listed. Personally, I don't feel precribing them to just about everyone is a great idea, but to each his own.

baltazar32 · Jun 8, 2016

there are lots of great responses here and all most all of them are true, your question is very valid but i thing u should consider a couple of points....first of all when u get prescribed both that means ur dr is not 100% sure about the cause of ur symptoms. never forget is all about how accurate ur GUEss is. so they give u steroids and antibiotics. if they think that the symptoms are more like an allergic reaction they give ur the higher dose of steroids with antibiotics ,,, i think u should also consider the factor of time and the half life of ur drug and the doses. it takes time for antibiotics to get to the desired level in blood and the steroids are faster...and about the yeast infection i would say its much better than having like 3 giant abscess on ur leg with pain and huge itching discomfort..try to add yogurt or those chocolate with probiotics..the rest is in the other's comm. good luck