Infection while on steroids any advice?

[Pompey3]

The good news is last week my GPA renal consultant agreed with my view that my GPA is in remission and my pains are probably PMR, and he is happy to treat as such, even told me to up the steroids to get to zero pain rather than coping on 2mg/day with ongoing discomfort - hoorah.

Last weekend I started to feel unwell, and have had a really rough week in bed and tied to the coach feeling like death. Covid test was negative so I assumed flu although the cough caused really bad burning pain and brown mucus plugs which were hard to cough out even with mucus thinner and saline nebuliser. I felt totally out of it and remembered that steroid use can increase risk of infections, so I got a GP call and antibiotics for chest infection prescribed and started - never had a chest infection before, in fact I haven’t had any respiratory type illness for probably a decade!

So my questions are:

1. do you stop tapering steroids while on antibiotics for a chest infection? I’m currently taking 7mg/day and aim to get back to 4mg

2. When you’ve been taking steroids albeit low dose for 2-3 years, will the antibiotic course need to be for longer than usual?

I’m on Clarithromycin 500 which is my normal antibiotic due to allergies, my GpA used to attack my airways so I’ve been prescribed this many times as a prevention drug post surgery but not for treating a chest infection. The GP has prescribed 7 days?

The good news is the antibiotics are working already, I’m “back in the room” and appetite back, and the searing pain coughing has gone. But still have a hacking cough and I’m super tired after pottering around.

Any advice on tapering and antibiotic use would be helpful.

Also any thoughts on how long it might take to get back to normal - gardening, walking nothing extreme!

[DorsetLady PMRGCAuk volunteer]

I wouldnt be reducing Pred when unwell, full stop. You body’s has enough to cope with fighting the infection-don’t put extra pressure on it trying to reduce at same time.

Whether you will require a longer dose of abx -who knows. Hopefully not.

Would also say you still need plenty of rest “pottering around” covers a lot of things.,,and as we discuss a lot -gardening can be a demon for PMR affected muscles…

[Pompey3 in reply to DorsetLady]

Hi firstly thank you so much for linking me to this site it’s really helpful for me to learn from.

Ok so no tapering until well again, I’ll follow that advice.

By pottering around I mean bed to sofa to bathroom to kitchen and back to sofa!

Gardening a dim and distant thought right now, and I discovered last year the problems caused by extended weeding in the same position - pMR pain flare ups! Digging is now delegated to my patient husband “my automated digging machine!” But I still do too much as soon as I can and then get pains again, I need to learn to limit what I do which isn’t easy.

Thanks for your advice much appreciated.

[DorsetLady PMRGCAuk volunteer in reply to Pompey3]

You're very welcome..

[PMRpro Ambassador]

Don't reduce when unwell, wait until you are better. You MIGHT even need to take more pred depending on how ill you are - Sick Day Rules explain, your body would normally produce more cortisol to boost the recovery process but can't after a long time on pred.

I have never found that being on pred impairs my recovery from infections. The pred actually helps with chest infections and is often prescribed alongside abx.

[Pompey3 in reply to PMRpro]

That’s reassuring thank you v much, I’m picking up but haven’t been so poorly for over a decade it’s really kicked me hard!

[PMRnewbie2017]

All I would add is there are some nasty viruses around at the moment. One is causing sinusitis accompanied by a post basal drip that's causing symptoms akin to bronchitis, but actually isn't. The cough is probably the worst I've ever had and is very productive and infected. It's proving very difficult to shift. I picked it up at the end of Jan, have had 2 bouts of associated conjunctivitis, three rounds of Doxycycline and am still fighting something. A sputum culture was negative so my GP is reluctant to keep prescribing antibiotics, but I'm still coughing and have a muffled sinus feeling and sore eyes....again.My OH is following in exactly the same symptom pattern. If anyone out there has the answer I'd love to hear it.