Ad­van­tage or not to ‘dual pre­scrib­ing’

Cape Breton Post - - IN MEMORIAM/ADVICE/GAMES - Keith Roach Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health news­let­ters at 628 Vir­ginia Dr., Or­lando, FL 32803. or from www.rb­ma­mall.com. (c) 2017 North Amer­ica Syndicate Inc. All Rights Re­serve

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 elected to take only the an­tibi­otic, with ex­cel­lent re­sults.

Since that time, three of my friends also were pre­scribed an­tibi­otics by three dif­fer­ent doc­tors for var­i­ous con­di­tions; all were also pre­scribed pred­nisone to take with it. Two of them did take the pred­nisone, re­sult­ing in re­ally un­pleas­ant side ef­fects.

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

Can you tell me if this dual pre­scrib­ing is a wide­spread med­i­cal trend or just a lo­cal one? Is there re­ally a good rea­son for pre­scrib­ing an­tibi­otics and pred­nisone to­gether? -- E.D.

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

How­ever, there is a down­side to steroids, as you note. It’s not just the un­pleas­ant im­me­di­ate side ef­fects, such as jit­ter­i­ness 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 must al­ways be weighed against the pos­si­ble harm.

This is par­tic­u­larly the case in peo­ple at high risk for side ef­fects, such as di­a­bet­ics (in whom sugar lev­els rou­tinely go up when tak­ing steroids) or those with high blood pres­sure (which of­ten is 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 quickly, how­ever.

In any case, I can’t con­done you not fol­low­ing your doc­tor’s rec­om­men­da­tions. I cer­tainly do rec­om­mend that you have a dis­cus­sion about the ben­e­fits ver­sus the harms, and rec­om­mend that you ask about nasal steroids.

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