BNF Section 12: EAR, NOSE & OROPHARYNX

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In patients with liver failure, blood levels of corticosteroid may be increased, as with other drugs which are metabolised in the liver. Because of the possibility of fluid retention, care must be taken when corticosteroids are administered to patients with renal insufficiency or hypertension or congestive heart failure. Live vaccines should not be given to individuals with impaired immune responsiveness caused by high doses of corticosteroids. Patients should carry 'steroid treatment' cards which give clear guidance on the precautions to be taken to minimise risk and which provide details of the prescriber, drug, dosage and the duration of treatment.

Again, these need to be done in hospital, and while they may improve pain in the short term, unfortunately they don't cure the arthritis or the pain in the long term. Medicines which are suitable for initiation and ongoing prescribing within primary care. Primary care prescribers take full responsibility for prescribing and monitoring. Secondary care use only as a mouthwash for a variety of oral mucosal diseases. Available as 8% and 13% ear drops for treatment of inflammation in otitis externa.

If no additional patient information is provided by the prescriber or pharmacist describing use as a mouthwash there is a risk the patient may swallow the solution. Restricted for cortisol replacement therapy of infants and young children withadrenal insufficiencywhere the hydrocortisone 10mg tablets cannot be used, either whole or halved, to administer the required dose. You’ll likely be offered topical or oral 5-ASAsbefore steroids. If your symptoms return when you try to reduce or stop taking steroids you may be offered an immunosuppressant, likeazathioprine or mercaptopurine, to take in combination with steroids. If your Colitis is severe and you’re not getting better with steroids and/or immunosuppressants, you may be offered abiologic medicine, such asinfliximaboradalimumab. There’s an increased risk of stomach ulcers and internal bleeding if you take nonsteroidal anti-inflammatory drugs , such as ibuprofen or aspirin, while you’re also taking steroids.

Prednisolone Soluble Tablets contain the equivalent of 5mg of prednisolone in the form of the 21-disodium phosphate ester. Administration of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate, intra-uterine growth retardation and effects on brain growth and development. There is no evidence that corticosteroids result in an increased incidence of congenital abnormalities, such as cleft palate/lip in man. However, when administered for prolonged periods or repeatedly during pregnancy, corticosteroids may increase the risk of intrauterine growth retardation.

Consequently ‘betamethasone 500 microgram soluble tablets for use as a mouthwash’ may not appear as a prepopulated option when generating a prescription or producing a dispensing label. Side effects of corticosteroids are well known as listed in the BNF. Many are serious including risk of adrenal crisis which was highlighted in the August 2020 NPSA Alert Steroid Emergency Card to support early recognition and treatment of adrenal crisis in adults. The National Reporting and Learning System has received a number of incident reports related to betamethasone soluble tablets prescribed as a mouthwash but mistakenly taken orally. One report described hospital admission for adrenal crisis. Reactions are common and may occur in both adults and children.

Clinical assessment of disease activity may be needed during withdrawal. If the disease is unlikely to relapse on withdrawal of systemic corticosteroids but there is uncertainty about HPA suppression, the dose of systemic corticosteroid may be reduced rapidly to physiological doses. Once a daily dose equivalent to 7.5mg prednisolone is reached, dose reduction should be slower to allow the HPA axis to recover. Prednisolone Soluble Tablets may be given early in the treatment of acute asthma attacks in children.

Use of antibiotic ear drops for this indication restricted to ENT Consultant/SpR only. These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety. To avoid the development of resistance, the treatment course should not exceed 7 days and the course not repeated on more than one occasion.