Two studies appearing in this edition of Pediatrics (Leszczynska et al and Goenka et al) have queried the impact of corticosteroids as adjuvant therapy for orbital cellulitis and retropharyngeal abscess (RPA) and parapharyngeal abscess (PPA), conditions that have traditionally been treated with antibiotics, with or without surgical drainage, on outcome of treatment. The subsidiary question that is raised by the design used by each study is whether administrative databases, such as the Pediatric Health Information System, are a viable approach to answering these questions. The first consideration is the biological plausibility of using steroids as an adjuvant in any infectious disease and the clinical models that exist to suggest that steroids may be beneficial. The use of corticosteroids in patients with bacterial meningitis, including that caused by Mycobacterium tuberculosis, is often cited as an example of the benefits of steroids in infection. The specific rationale for use of corticosteroids is its antiinflammatory effects, which may result in decreases of swelling and/ or edema to facilitate drainage, perfusion, reduction in pain, and healing.
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