“I’m here (cough) to pick up (cough) the steroid,” says the visibly sick patient at the pharmacy. The pharmacist tries not to breathe in too deeply to catch the contagion as she hands over the box of pills. The patient has no idea that others have nicknamed it “poison” or “the Devil’s drug,” because it’s not worth it. The risks of casually prescribing prednisone or Medrol Dosepaks for seasonal illnesses are often overlooked by doctors and pharmacists. There is little awareness of the potential dangers linked to this common practice, and the minimal (if any) benefits do not justify the risks.
Efforts to reduce inappropriate antibiotic use through Antibiotic Stewardship Programs have been successful, with azithromycin prescriptions dropping by 75 percent over the past decade. Perhaps it’s time for a similar initiative to address the overprescribing of steroids for seasonal illnesses, not due to resistance issues, but because of the significant side effects they can cause with no apparent benefit.
A Medrol Dosepak (methylprednisolone, a steroid also referred to as a corticosteroid or glucocorticoid) is intended for short-term treatment of inflammatory conditions. The Dosepak is a punch pack with enough pills for six days of treatment, with each day taking one fewer pill in a taper. It seems so easy to just hand it out like candy, because what’s the harm of only six days of treatment?
Prescribing oral steroids like Medrol or prednisone may seem harmless, but there is often no significant benefit for many of the conditions they are prescribed for. In cases of influenza, bronchitis, cough, cold, RSV, COVID-19, sinus infection, otitis media, strep throat, or community-acquired pneumonia, the risks outweigh any potential benefits.
In simpler terms, if a child can catch an illness at school, there is no justification for prescribing oral steroids to treat that sickness.
Short-term steroid side effects
So, what are the harms of short-term steroid prescriptions?
A retrospective study of 1.5 million insured adults found that 21 percent received short-term steroid prescriptions, which led to increased risks within 30 days of the following: a nearly five times greater risk of sepsis, a three times greater risk of venous thromboembolism, and a 1.8 times greater risk of fractures.
In a study of patients with pneumonia, prednisone 50 mg for seven days compared to a placebo showed a 2.5 times greater risk of recurrent pneumonia, a two times greater risk of secondary infections, and an eight times greater risk of insulin dependence 180 days later.
Just one dose of dexamethasone 4 mg had a “tremendous impact” on immune and metabolism markers in healthy volunteers, leading to the deregulation of 150 out of 214 metabolites tested. The circadian rhythm, metabolism, immune system, and sleep patterns were severely affected by a single dose of steroid.
[Image of circadian rhythm disruption due to steroids]
A 2025 JAMA Review showed that 14 days of steroids in children was associated with an increased risk for hyperglycemia, sleep disturbances, and GI bleeding.
The most tweeted side effect of steroids is insomnia. It doesn’t make very much sense to prescribe a medication that will cause sleep loss when sleep is one of the most powerful healing mechanisms. It would be better to simply prescribe sleep and chicken noodle soup.
Other short-term side effects of steroids reported in studies include euphoria, anxiety, psychosis and other neuropsychiatric adverse events, headache, intense hunger cravings, hot flashes, arrhythmias, myopathy, abdominal discomfort, swelling, and adrenal suppression.
[Image of side effects of prednisone]
Many patients have reached out to me wishing they had never taken their prescription for steroids because of how horrible the side effects are. Normally healthy people before the steroid prescription will suddenly have panic attacks and severe anxiety making them unable to work, drive, or take care of their children. Not only did it give them harmful side effects, but it didn’t even help the original sickness they took it for.
As neurologist James F. Howard of UNC-Chapel Hill stated, “Prednisone is the most hated drug in the world. It should be banned in most instances.”
Seasonal sicknesses with no evidence of clinical benefit from steroid treatment
At this point, you might be thinking that for one of the seasonal sicknesses mentioned above, there’s got to be an exception. Let me go through the lack of proven benefits for each illness.
Steroid prescriptions increase the risk of death in influenza cases. A meta-analysis on influenza revealed a nearly four times greater mortality risk with a 3.9 odds ratio. The IDSA guidelines advise against corticosteroid therapy for suspected or confirmed seasonal influenza, influenza-associated pneumonia, respiratory failure, or ARDS, unless clinically necessary for other reasons.
For bronchitis and cough, oral steroids were not shown to be more effective than placebo for reducing the severity or duration of cough in randomized trials. Steroids do not reduce the need for hospitalization in RSV or bronchiolitis.
For non-hospitalized patients with COVID-19, prescriptions for dexamethasone, prednisone, or other corticosteroids may be associated with poorer clinical outcomes and have no evidence of benefit.
A Cochrane review concluded that oral corticosteroids appear to be ineffective for adult patients with acute sinusitis. Steroid pills don’t help sinus infections. Topical steroids, like intranasal fluticasone spray, may help sinusitis.
Neither oral nor nasal steroids “hasten the clearance of middle ear fluid and are not recommended,” states the treatment guideline for otitis media. A clinical practice guideline recommends against systemic steroids for middle ear effusion in children.
The IDSA guidelines for strep throat, also known as group A strep pharyngitis, state that “adjunctive therapy with a corticosteroid is not recommended.”
For community-acquired pneumonia (CAP), a 2025 JAMA publication showed that in seven randomized controlled trials of patients with less severe CAP, there was no difference in mortality.
Rare exceptions for oral steroids
The only exception is for patients with COPD or asthma. As UpToDate stated, “In these circumstances, the use of glucocorticoids is for the treatment of acute exacerbation of COPD, not for the treatment of community-acquired pneumonia.”
Otherwise, only for critically ill, hospitalized patients was there a possible benefit of steroids. In that case, the patient is probably unable to take oral steroids anyway. No point in a Medrol Dosepak of pills when a patient is intubated; IV would be more appropriate.
Stop prescribing steroids for seasonal sicknesses.
Therefore, for no sicknesses (or complications of sicknesses) that a kid can bring home from school should steroid pills ever be prescribed. The evidence shows that the risks for harm outweigh the benefit for these conditions.
Just as the Lorax advocates for the trees, I advocate for the millions of patients who receive unnecessary and harmful steroid prescriptions. Following the principle of “First, do no harm,” it is evident that steroid prescriptions offer no discernible advantages for seasonal sicknesses and do cause harm. It is crucial to cease prescribing steroids for seasonal illnesses as they are ineffective and pose risks. Please stop prescribing steroids for seasonal sicknesses.
Do we need a steroid stewardship program to reign in these harmful prescriptions?
Megan Milne is an ambulatory care pharmacist.
