What is the role of corticosteroid therapy for leptospirosis?

Updated: Jul 08, 2021
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Corticosteroid therapy is controversial. However, it might be beneficial in severe disease and/or cases with pulmonary involvement. Larger, prospective studies are needed for evidence-based recommendations. 

A 2014 review suggests lack of benefit and possible increased risk of nosocomial infection. [52]  As with severity of illness, response may vary depending on host immune factors or the particular virulence of the leptospire. Treatment with high-dose pulsed methylprednisolone (30 mg/kg/d, not to exceed 1500 mg) has been used successfully to treat patients with leptospiral renal failure without dialysis. This approach may have be beneficial in resource-poor areas where dialysis is unavailable and would involve lengthy medical transport. The use of renal-dose dopamine in conjunction with steroids or diuretics has also been described. [24]


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