NHS Highland Guidance on use of corticosteroids (dexamethasone, prednisolone and hydrocortisone) for adults with confirmed SARS-CoV-2 infection (CEM/CNO/2020/033 published 3rd September 2020)
Corticosteroids, and in particular dexamethasone, prednisolone and hydrocortisone, have been demonstrated to have a place in the management of patients with COVID-19. Following recent publication of the REMAP-CAP trial for hydrocortisone and a meta-analysis of corticosteroids, the World Health Organization (WHO) has issued new interim guidance recommending the use of systemic corticosteroids in severe and critical COVID-19 disease.
The approach to utilisation of corticosteroids in COVID-19 is informed by the extensive experience of the use of this class of medicines for other indications and the information from the REACT meta-analysis where a clinical benefit was demonstrated. The REACT study includes results from seven randomised controlled trials (RCTs), including the RECOVERY and REMAP-CAP trials. The majority of evidence in the published meta-analysis emanates from the assessment of dexamethasone in the RECOVERY trial. Currently, there are no data directly comparing dexamethasone with hydrocortisone.
This guidance document has been updated with information from NICE COVID-19 rapid guideline: Managing COVID-19 version 13.0 published 04.10.2021
This information replaces previously issued alerts on the use of dexamethasone in COVID-19 (CEM/CNO/2020/026) which was published on 16th June 2020.
Note: For information on use and doses in children, pregnant or breast-feeding women, please see:
the full NICE guidance, Royal College of Obstetrics and Gynaecology guidance and risk criteria set out in Royal College of Paediatric and Child Health Guidance for assessing children admitted to hospital with COVID-19.