“I’m here (cough) to pick up (cough) the steroid,” says the visibly sick patient at the pharmacy. The pharmacist instinctively holds her breath as she hands over the box of pills. Many patients don’t realize this common medication is sometimes called “poison” or “the Devil’s drug,” and the potential downsides are often underestimated. Oral steroids like prednisone and methylprednisolone are frequently prescribed for routine illnesses, but the risks often outweigh the benefits.
Over the past decade, efforts to curb unnecessary antibiotic use through Antibiotic Stewardship Programs have seen azithromycin prescriptions drop by 75 percent, according to data from ClinCalc. Perhaps it’s time for a similar initiative to address the overprescribing of steroids for seasonal illnesses—not because of antibiotic resistance, but due to the significant side effects they can cause without providing clear clinical improvement.
A Medrol Dosepak (methylprednisolone) is designed for short-term treatment of inflammatory conditions, typically delivered in a six-day taper. It’s easy to dismiss the potential harm of just six days of treatment, but that assumption is often incorrect.
While oral steroids like Medrol or prednisone may seem harmless, they often offer no significant benefit for conditions like influenza, bronchitis, coughs, colds, RSV, COVID-19, sinus infections, ear infections, strep throat, or community-acquired pneumonia. In many cases, the risks simply aren’t worth it.
Simply put, if a child catches an illness at school, prescribing oral steroids is rarely justified.
What are the risks of short-term steroid use?
A retrospective study analyzing 1.5 million insured adults found that 21 percent received short-term steroid prescriptions. Within 30 days, these patients experienced a nearly five times greater risk of sepsis, a three times greater risk of venous thromboembolism, and an 1.8 times greater risk of fractures.
In a study of patients with pneumonia, a seven-day course of prednisone 50 mg, compared to a placebo, resulted in a 2.5 times greater risk of recurrent pneumonia, a two times greater risk of secondary infections, and an eight times greater risk of developing insulin dependence 180 days later.
Even a single dose of dexamethasone 4 mg can have a “tremendous impact” on the body, according to research. A study found that just one 4 mg dose deregulated 150 out of 214 metabolites tested, severely affecting circadian rhythm, metabolism, immune function, and sleep patterns, as reported in published research.
A 2025 review in JAMA Network Open showed that 14 days of steroid use in children was linked to an increased risk of hyperglycemia, sleep disturbances, and gastrointestinal bleeding.
Insomnia is the most frequently reported side effect of steroids. Prescribing a medication that disrupts sleep is counterproductive, as sleep is a powerful healing mechanism. Often, rest and chicken noodle soup are more effective remedies.
Other short-term side effects reported in studies include euphoria, anxiety, psychosis, neuropsychiatric events, headache, intense hunger, hot flashes, arrhythmias, muscle weakness, abdominal discomfort, swelling, and adrenal suppression, according to research.
Many patients have told me they regret taking steroids due to the severe side effects they experienced. Previously healthy individuals have developed panic attacks and debilitating anxiety, impacting their ability to work and care for their families—all without any improvement in their original illness.
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.”
When steroids don’t help seasonal illnesses
Let’s examine the lack of proven benefits for common seasonal illnesses.
Steroid prescriptions increase the risk of death in influenza cases. A meta-analysis revealed a nearly four times greater mortality risk (odds ratio of 3.9). The Infectious Diseases Society of America (IDSA) advises against corticosteroids for influenza, influenza-associated pneumonia, respiratory failure, or ARDS, unless clinically necessary for other reasons.
For bronchitis and cough, oral steroids haven’t been shown to be more effective than placebo in reducing cough severity or duration, according to randomized trials. Steroids also don’t reduce hospitalization rates for RSV or bronchiolitis.
For non-hospitalized patients with COVID-19, prescriptions for dexamethasone, prednisone, or other corticosteroids may be associated with poorer outcomes and offer no benefit.
A Cochrane review concluded that oral corticosteroids are ineffective for acute sinusitis in adults. Steroid pills don’t help sinus infections, but topical steroids like intranasal fluticasone spray may.
Neither oral nor nasal steroids “hasten the clearance of middle ear fluid and are not recommended,” states the American Academy of Family Physicians’ 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 state that “adjunctive therapy with a corticosteroid is not recommended.”
For community-acquired pneumonia (CAP), a 2025 JAMA publication showed no difference in mortality between patients receiving steroids and those receiving a placebo in seven randomized controlled trials of less severe cases.
When are oral steroids appropriate?
The primary exception is for patients with COPD or asthma. As UpToDate explains, “In these circumstances, glucocorticoids are used to treat acute exacerbations of COPD, not community-acquired pneumonia.”
Otherwise, steroids may be beneficial only for critically ill, hospitalized patients. In those cases, oral administration is often not feasible, and intravenous steroids would be more appropriate.
It’s time to stop prescribing steroids for routine illnesses.
For any illness a child might bring home from school, steroid pills should not be prescribed. The evidence clearly demonstrates that the risks outweigh any potential benefit for these conditions.
Just as advocates champion environmental protection, I advocate for patients who receive unnecessary and harmful steroid prescriptions. Adhering to the principle of “First, do no harm,” it’s clear that steroid prescriptions offer no discernible advantages for seasonal illnesses and can cause significant harm. It’s crucial to cease prescribing steroids for these conditions.
Is it time for a steroid stewardship program to address these harmful prescribing practices?
