Rational Corticosteroid Use: An Evidence-Based Narrative Review of Steroid Stewardship to Enhance Patient Safety Across Healthcare Settings.
7 affiliations
- 1Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru, KA, India.
- 2Department of Basic Medical Science, College of Applied Medical Sciences, Khamis Mushayt Campus, King Khalid University, Abha, Saudi Arabia.
- 3Department of Clinical Immunology and Rheumatology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, KA, India.
- 4Department of Pharmaceutics, College of Pharmacy, King Khalid University, Al Faraa, Abha, 62223, Saudi Arabia.
- 5Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, 11942, Jordan.
- 6Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdul Aziz University, Al Kharj, 11942, Saudi Arabia.
- 7Department of Pharmacology, Orotta College of Medicine and Health Science, Asmara, Eritrea.
Abstract
Corticosteroids are potent medicines that are commonly used to treat inflammation, autoimmune conditions, and acute illnesses. Overuse or misuse can cause serious side effects like high blood sugar, slow growth, mood swings, infections, and adrenal insufficiency. This narrative review examines the need for structured steroid stewardship programs (SSPs) to optimize patient therapeutic outcomes. We derive the evidence from real-world prescribing studies, pharmacovigilance reports, and stewardship intervention trials published between 2015 and 2025, with emphasis on post-marketing safety data. Worldwide, 5-10% of hospitalized patients get systemic steroids every year. In India, the percentage of patients who get them is between 2% and 34%. Adverse effects occur in nearly 50% of the patients on long-term use. Effective stewardship components include multidisciplinary teams, prescription audits, standardized tapering protocols (10-20% dose reduction every 7-15 days), handheld steroid emergency cards, and educating patients on "sick day rules". The patient-centered outcomes, including quality of life, treatment satisfaction, and adrenal crisis prevention, remain underreported. To ensure long-term safety and sustainability, stronger collaborative initiatives between healthcare providers and policymakers are essential. We propose a five-component stewardship framework with potential safety indicators: (1) steroid emergency cards, (2) prescription audits by pharmacists, (3) standardization of tapering protocols, (4) patient education on sick-day rules, and (5) monitoring of outcomes including adrenal crisis rates and hyperglycemic events. The framework is intended to support safer corticosteroid use and improve medication safety, but its feasibility and effectiveness need to be evaluated prospectively across different healthcare settings.
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BibTeX
@article{khan2026rational,
title = {{Rational Corticosteroid Use: An Evidence-Based Narrative Review of Steroid Stewardship to Enhance Patient Safety Across Healthcare Settings.}},
author = {Mohammed Daiyaan Khan and Srikanth Malavalli Siddalingegowda and Md Zeyaullah and Ramaswamy Subramanian and Mohamed Rahamathulla and Yazan AlRashdan and Mohammed Muqtader Ahmed and Ismail Pasha},
journal = {Drug, healthcare and patient safety},
year = {2026},
month = oct,
doi = {10.2147/dhps.s620997},
url = {https://europepmc.org/article/MED/42904150},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Rational Corticosteroid Use: An Evidence-Based Narrative Review of Steroid Stewardship to Enhance Patient Safety Across Healthcare Settings.
AU - Mohammed Daiyaan Khan
AU - Srikanth Malavalli Siddalingegowda
AU - Md Zeyaullah
AU - Ramaswamy Subramanian
AU - Mohamed Rahamathulla
AU - Yazan AlRashdan
AU - Mohammed Muqtader Ahmed
AU - Ismail Pasha
PY - 2026
DA - 2026/10/16
JO - Drug, healthcare and patient safety
DO - 10.2147/dhps.s620997
UR - https://europepmc.org/article/MED/42904150
AB - Corticosteroids are potent medicines that are commonly used to treat inflammation, autoimmune conditions, and acute illnesses. Overuse or misuse can cause serious side effects like high blood sugar, slow growth, mood swings, infections, and adrenal insufficiency. This narrative review examines the need for structured steroid stewardship programs (SSPs) to optimize patient therapeutic outcomes. We derive the evidence from real-world prescribing studies, pharmacovigilance reports, and stewardship intervention trials published between 2015 and 2025, with emphasis on post-marketing safety data. Worldwide, 5-10% of hospitalized patients get systemic steroids every year. In India, the percentage of patients who get them is between 2% and 34%. Adverse effects occur in nearly 50% of the patients on long-term use. Effective stewardship components include multidisciplinary teams, prescription audits, standardized tapering protocols (10-20% dose reduction every 7-15 days), handheld steroid emergency cards, and educating patients on "sick day rules". The patient-centered outcomes, including quality of life, treatment satisfaction, and adrenal crisis prevention, remain underreported. To ensure long-term safety and sustainability, stronger collaborative initiatives between healthcare providers and policymakers are essential. We propose a five-component stewardship framework with potential safety indicators: (1) steroid emergency cards, (2) prescription audits by pharmacists, (3) standardization of tapering protocols, (4) patient education on sick-day rules, and (5) monitoring of outcomes including adrenal crisis rates and hyperglycemic events. The framework is intended to support safer corticosteroid use and improve medication safety, but its feasibility and effectiveness need to be evaluated prospectively across different healthcare settings.
SN - 1179-1365
ER -