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Children who are on immunosuppressant drugs are more susceptible to infections than healthy childrenChicken pox and measlesfor examplecan have a more serious or even fatal course in children on immunosuppressant corticosteroidsIn such childrenor in adults who have not had these diseasesparticular care should be taken to avoid exposureIf exposedtherapy with varicella zoster immune globulinVZIGor pooled intravenous immunoglobulinIVIGas appropriatemay be indicatedIf chicken pox developstreatment with antiviral agents may be considered.

The lowest possible dose of corticosteroid should be used to control the condition being treatedA gradual reduction in dosage should be made when possible.

Corticosteroids may mask some signs of infectionand new infections may appear during their useThere may be decreased resistance and inability to localize infection when corticosteroids are usedIf an infection occurs during fludrocortisone acetate therapyit should be promptly controlled by suitable antimicrobial therapy.

Corticosteroids are thought to actat least in partby controlling the rate of synthesis of proteinsAlthough there are a number of instances in which the synthesis of specific proteins is known to be induced by corticosteroidsthe links between the initial actions of the hormones and the final metabolic effects have not been completely elucidated.

Prolonged use of corticosteroids may produce posterior subcapsular cataractsglaucoma with possible damage to the optic nervesand may enhance the establishment of secondary ocular infections due to fungi or viruses.

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