Administration routes for antimicrobial agents used in clinical practice include the topical, inhaled, enteral and parenteral routes.
In the top five highest prevalence drugs topical inhaled and systemic steroids, oral contraceptives, and topical or systemic antifungal drugs were most commonly used off label.
For variables for which there was a difference between the glucocorticoid-treated and -untreated groups, we explored dose response relationships by comparing groups receiving topical, inhaled or systemic therapy.
Only when the primary analysis showed a statistically significant difference, a secondary analysis was performed to examine dose response relationships by comparing those receiving glucocorticoids by topical, inhaled or systemic (oral or i.m).
Cardiometabolic variables, body fat distribution, cognitive function and mood were studied in the 1066 participants of the Edinburgh Type 2 Diabetes Study, of whom 162 (15%) were taking systemic, topical or inhaled glucocorticoids.
Exclusion criteria included a medical history of disorders involving glucocorticoid, mineralocorticoid, or androgen excess; a history of type 1 diabetes or secondary forms of diabetes; previous insulin therapy; triglycerides >500 mg/dl; and treatment with any oral, systemic, topical, or inhaled glucocorticoids, thiazolidinediones, or exenatide within 3 months of screening.
So you can't simply do it on a weight basis; you have to understand how you're administering the drug — whether inhaled, topical, oral, or intravenous — and what organs within the body break it down and excrete it.
Of these, 12% were taking topical glucocorticoids, 70% inhaled glucocorticoids and 23% oral glucocorticoids.
Although the oral route is most commonly associated with iatrogenic Cushing's syndrome, any mode of delivery, including inhaled, topical, or injectable glucocorticoids, should be sought.
We can assume that people taking a regular dose of 5 mg of prednisolone (or equivalent) have compromised adrenal reserve; however, the degree of HPA axis suppression in persons taking inhaled, topical or intra-articular GCs is unknown.
Our data on use support the conclusions of the recently published EMEA consensus/expert derived list of research priorities concerning off patent medicinal products, 16 which emphasised the need for paediatric studies of the safety of topical, systemic, and inhaled steroids.
