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Published ahead of print on August 28, 2003, doi:10.1164/rccm.200306-766OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 12, December 2003, 1449-1456

A more recent version of this article appeared on December 15, 2003
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Submitted on June 10, 2003
Accepted on August 25, 2003

HIGH DOSE PULSE VERSUS NON-PULSE CORTICOSTEROID REGIMENS IN SEVERE ACUTE RESPIRATORY SYNDROME

James C Ho1, Gaik C Ooi2, Thomas Y Mok3, Johnny W Chan3, Ivan Hung1, Bing Lam1, Poon C Wong1, Patrick C Li3, Pak L Ho4, Wah K Lam1, Chun K Ng3, Mary S Ip1, Kar N Lai1, Moira Chan-Yeung1, and Kenneth W Tsang1*

1 Medicine, The University of Hong Kong, Hong Kong, China, 2 Diagnostic Radiology, The University of Hong Kong, Hong Kong, China, 3 Medicine, Queen Elizabeth Hospital, Hong Kong, China, 4 Microbiology, The University of Hong Kong, Hong Kong, China

* To whom correspondence should be addressed. E-mail: kwttsang{at}hkucc.hku.hk.

The treatment of severe acute respiratory syndrome (SARS) pneumonia is controversial, and the efficacy of corticosteroid therapy is unknown. We have evaluated the clinical and radiographic outcomes of 72 probable SARS patients (median age 37 yr, 30 M), who received ribavirin and different steroid regimens in two regional hospitals. Chest radiographs were scored according to percentage of lung field involved. Seventeen patients initially received pulse (PS, methylprednisolone >=500mg/d), and 55 received initial non-pulse (NPS, methylprednisolone <500mg/d) steroid therapy. The cumulative steroid dosage, and intensive care unit admission, mechanical ventilation and mortality rates, and hematological and biochemical parameters were similar in both groups after 21 days. However, PS patients had less oxygen requirement, better radiographic outcome, and less likelihood to require rescue pulse steroid therapy than their counterparts. There was no significant difference between the two groups in hemolytic anemia, severe secondary infections or hematemesis, but PS patients had less hyperglycaemia. Initial use of pulse methyprednisolone therapy appears to be a more efficacious and equally-safe steroid regimen when compared with regimens with lower dosage, and should be considered as the preferred steroid regimen in the treatment of SARS, pending data from future randomized controlled trials.
Key words: Severe acute respiratory syndrome, ribavirin, corticosteroid




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