Place de la corticothérapie dans l'arsenal thérapeutique aux urgences : mise au point

Corticoids, or glucocorticoids or corticostéroids are used under two forms in therapeutic: hydrocortisone, that have the same properties that natural cortisol, and is used as hormonal substitution and synthetic glucocorticoids witch are used for their anti-inflammatory properties. Because of their intranuclear actions, latency of efficacy could be a limitation in their use during emergency therapy. They have a major place in the emergency armamentarium There is good evidence for their use during asthma exacerbation, anaphylaxis and brain neoplasm. In other cases as COPD exacerbation, acute alcoholic hepatitis, therapeutic indications vary under disease severity and the ratio benefit/risk seem to be less clear. In must be underlined that corticoids use is not without advert event and inappropriate use could be associated with increased mortality. These prescriptions have to be done in a strict pattern of indications, posology and length, in regard of their expected benefit, their delay of efficacy (except for bacterial meningitis) allow to postpone therapeutic introduction instead of start an immoderate corticotherapy.