The Use of Corticosteroids in SARS

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Abstract
The use of systemic corticosteroids in patients with the severe acute respiratory syndrome (SARS) is of serious concern. Lee and colleagues report anecdotal success in their article on SARS elsewhere in this issue.1 And in the recent Web broadcast on SARS by the CDC, Dr. Sung, one of the coauthors, states, “High-dose steroid should be given early to stop the progression of the disease.”2 The pathogenesis of SARS is diffuse alveolar damage with the acute respiratory distress syndrome (ARDS), not bronchiolitis obliterans with organizing pneumonia. And SARS is most likely due to coronavirus pneumonitis. Early treatment with corticosteroids in patients with ARDS is highly controversial and is not a standard of care, at least in North America. Although ribavirin has activity against coronaviruses and human metapneumoviruses in vitro, there are no antimicrobial agents with proven effectiveness for the treatment of SARS at this point. And the use of corticosteroids with possibly ineffective antiviral agents in patients with viral-induced pneumonitis or ARDS can be hazardous. I believe systemic corticosteroids should not be used at least until the etiologic agent of SARS has been confirmed and effective antiviral agents have been established.

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