Corticosteroid-Associated Infections

Introduction to Corticosteroid Risks

• The use of corticosteroids like prednisone can compromise the immune response and increase susceptibility to opportunistic infections, particularly fungal infections such as Candida species 1
• Doses equivalent to ≥20 mg of prednisolone for ≥2 weeks significantly increase the risk of infection 1

Clinical Presentation of Oral Candidiasis

• Oral candidiasis (thrush) may appear as a rash or white patches in the throat after yogurt consumption due to immunosuppression, characterized by white or cream-colored patches that can be scraped off, leaving red or bleeding areas underneath 1
• The visual appearance of fungal infections in the throat includes redness or irritation, which can be distinguished from bacterial infections 1

Management of Oral Candidiasis

• For oral/throat candidiasis, topical antifungal medications like nystatin oral suspension or clotrimazole troches are recommended, with systemic antifungals like fluconazole considered for more severe cases 2
• Patients on prednisone should continue their prescribed medication for the underlying condition but may consider tapering to the lowest effective dose if medically appropriate, under the guidance of a healthcare provider 2

Preventive Measures

• Maintaining excellent oral hygiene while on prednisone, including rinsing the mouth with water after using inhaled corticosteroids, can help prevent oral candidiasis 2
• Limiting consumption of sugary foods that can promote fungal growth and considering prophylactic antifungal rinses for long-term high-dose prednisone therapy are also recommended 2

Dietary Considerations

• Temporarily avoiding yogurt and other dairy products until the infection resolves, and considering probiotic supplements that don't contain dairy if beneficial for the underlying condition, can help manage the risk of exacerbating fungal infections 2