PMR dose reduction following hospital stay for cellulitis

[Anness]

I have had a bad bout of cellulitis and am on IV antibiotics for past week. On admission to hospital in AandE they upped my dose from 4mg to 10mg. If I am on this higher dose for let’s say just 10 days while I am on IV antibiotics how quickly can I drop back to usual dose? Do I need slow reduction programme if dose is upped for just a very short period?

[SnazzyD]

Oh dear, that’s not very nice. I think perhaps you need to ask that question a few more bends down the road. Once you know how your recovery goes, at least in the acute phase, it’ll become more clear. Depends if they discharge you on oral antibiotics for example or whether you respond quickly to this first IV course. You may get specific instructions too, upon discharge, as they might want a bit longer on 10mg to prevent not only adrenal problems but a flare as well. If it was me and I was just up for 10 days and it was uncomplicated, I think I’d give myself a reduction over 2-4 weeks watching very carefully for adrenal problems, but that’s just me. I’m sure get more advice here soon.

[DorsetLady PMRGCAuk volunteer]

Like SnazzyD says see what instructions you get on release.

But I would suggest maybe - drop to 7.5mg for 2 weeks, then 5mg for 2 weeks and then continue your taper from there. But it all depends on how you feel, and what advice you get.

[Anness in reply to DorsetLady]

Thank you. Advice helpful. Meanwhile most of the docs

I have seen here have been just lovely but are fresh out of med school while other colleagues elsewhere in hospital to support coronavirus. They are doing so well but don't yet have the experience that is evident on this group. What a baptism of fire for this new cohort of doctors!

[PMRpro Ambassador]

Theoretically after 10 days you coud drop straight back to 4mg but as Snazzy says, I doubt it will be as simple at that. The doubling of the pred will have been not only to provide adrenal support (sick days) but also to reduce the inflammation from the cellulitis.

If they can't come up with a confidence-inspiring answer I'd do as Snazzy suggests, take a couple of weeks about it.

[Anness]

Thanks so much. Very helpful. Doesn’t sound too bad. I really want to avoid the side effects of 10 mg so get back down as soon as possible.