Glucocorticoids as Adjunctive Therapy in Infectious Diseases—Immunomodulation in the Management of Infection-Related Inflammation

Abstract

Abstract: Glucocorticoids (GCs) represent a critical adjunctive strategy in the management of select infectious diseases, particularly those in which the host inflammatory response, rather than direct pathogen toxicity, is the primary driver of morbidity and mortality. This review synthesizes evidence-based indications for GC use across bacterial, viral, fungal, and parasitic infections, with emphasis on agent selection, dosing, duration, and the clinical principle that steroids must always be co-administered with definitive antimicrobial therapy. The conditions discussed include bacterial meningitis, tuberculosis (meningitis and pericarditis), PCP, COVID-19, septic shock, croup, and selected fungal and parasitic infections. Contraindications, most notably cerebral malaria, are highlighted. The evidence base ranges from landmark randomized controlled trials to consensus guidelines.