Cortisone 25mg = Hydrocortisone 20mg = Prednisone 5mg = Prednisolone 5mg = Methylprednisolone 4mg = Triamcinolone 4mg = Betamethasone 0.8mg = Dexamethasone 0.75mg = Clobetasol 0.5mg

(1) Strictly adhere to the indications for glucocorticoid therapy

Glucocorticoids are a class of drugs with a wide range of clinical indications, especially relative indications. However, their clinical use is often arbitrary, and they are not strictly administered according to indications. For example, glucocorticoids are used solely for the purpose of reducing fever and pain, especially in infectious diseases. Glucocorticoids have immunosuppressive effects but are not suitable for all autoimmune diseases such as chronic lymphocytic thyroiditis (Hashimoto's disease), type 1 diabetes, and psoriasis vulgaris.

(2) Formulate a reasonable glucocorticoid treatment plan

The glucocorticoid treatment plan should be formulated based on the patient's condition and the characteristics of the drug. The treatment plan includes the selection of the type of drug, dosage, course of treatment, and route of administration. In this guideline, unless otherwise specified, the route of administration is systemic, i.e., oral or intravenous administration.

1. Selection of type: Different glucocorticoids have different pharmacodynamics and pharmacokinetics (absorption, distribution, metabolism, and excretion) characteristics, and therefore have different clinical indications. The appropriate type of glucocorticoid should be selected based on the characteristics of the disease and the glucocorticoid.

2. Dosage: Physiological and pharmacological doses of glucocorticoids have different effects and should be selected according to different therapeutic purposes. Generally, the dosage (using prednisone as an example) can be divided into the following situations:

(1) Long-term maintenance dose: 2.5-15.0 mg/d;

(2) Low dose: <0.5mg·kg^-1·d^-1;

(3) Medium dose: 0.5-1.0 mg·kg^-1·d^-1;

(4) High dose: >1.0 mg·kg^-1·d^-1;

(5) Pulse dose (using methylprednisolone as an example): 7.5-30.0 mg·kg^-1·d^-1.

3. Course of treatment: The course of glucocorticoid treatment varies for different diseases and can generally be divided into the following situations:

(1) Pulse therapy: The course is usually less than 5 days. It is suitable for the rescue of critically ill patients, such as fulminant infections, anaphylactic shock, severe asthma status, anaphylactic laryngeal edema, lupus encephalopathy, severe bullous skin diseases, severe drug eruptions, and rapidly progressive nephritis. Pulse therapy should be combined with other effective treatments and can be quickly discontinued. If ineffective, pulse therapy should not be repeated in a short period of time.

(2) Short-term therapy: The course is less than 1 month, including stress therapy. It is suitable for infectious or allergic diseases, such as tuberculous meningitis and pleuritis, exfoliative dermatitis, or acute rejection after organ transplantation. Short-term therapy should be combined with other effective treatments, and the medication should be gradually reduced to discontinuation.

(3) Medium-term therapy: The course is within 3 months. It is suitable for diseases with a longer course and multiple organ involvement, such as rheumatic fever. After the effect is achieved, reduce to the maintenance dose, and gradually decrease when stopping the medication.

(4) Long-term therapy: The course is more than 3 months. It is suitable for the prevention and treatment of rejection after organ transplantation and chronic autoimmune diseases with recurrent episodes and multiple organ involvement, such as systemic lupus erythematosus, hemolytic anemia, systemic vasculitis, sarcoidosis, bullous skin diseases, etc. Maintenance therapy can be administered daily or every other day, and the medication should be gradually reduced to discontinuation.

(5) Lifelong replacement therapy: It is suitable for primary or secondary chronic adrenal insufficiency, and the dose should be appropriately increased under various stress conditions.

4. Route of administration: Includes oral, intramuscular injection, intravenous injection or infusion for systemic use, and inhalation, local injection, drip, and application for local use.

(3) Emphasize comprehensive treatment of diseases

In many cases, glucocorticoid therapy is only part of the comprehensive treatment of the disease. It should be combined with other treatment methods based on the patient's actual situation. For example, in patients with severe infections, glucocorticoids can be used to relieve symptoms under the premise of active and effective anti-infection treatment and various supportive treatments.

(4) Monitor adverse reactions of glucocorticoids

Adverse reactions of glucocorticoids are significantly related to the type, dose, course, dosage form, and method of administration. Adverse reactions should be closely monitored during use, such as infections, metabolic disorders (water and electrolyte, blood sugar, blood lipids), weight gain, bleeding tendency, abnormal blood pressure, osteoporosis, femoral head necrosis, etc. Children should be monitored for growth and development.

(5) Pay attention to withdrawal reactions and rebound phenomena

Glucocorticoid reduction should be individualized under close observation of the disease and glucocorticoid response, and the following phenomena should be noted:

1. Withdrawal reaction: When glucocorticoids are used in medium or high doses for a long time, rapid reduction or sudden discontinuation can cause symptoms similar to adrenal insufficiency. Mild cases may present with lethargy, fatigue, loss of appetite, joint and muscle pain, while severe cases may present with fever, nausea, vomiting, hypotension, and in critical cases, adrenal crisis requiring emergency treatment.

2. Rebound phenomenon: When glucocorticoids are used for a long time, rapid reduction or sudden discontinuation can cause the primary disease to recur or worsen. Glucocorticoid therapy should be resumed, often with an increased dose, and gradually reduced after stabilization.