title: Systematic Review of the Toxicity of Long-Course Oral Corticosteroids in Children.
abstract: BACKGROUND
  Long courses of oral corticosteroids are commonly used in children in the management of chronic conditions. Various adverse drug reactions (ADRs) are known to occur with their use. This systematic review aimed to identify the most common and serious ADRs and to determine their relative risk levels.
  
  
  METHODS
  A literature search of Embase, Medline, International Pharmaceutical Abstracts, CINAHL, Cochrane Library and PubMed was performed with no language restrictions in order to identify studies where oral corticosteroids were administered to patients aged 28 days to 18 years of age for at least 15 days of treatment. Each database was searched from their earliest dates to January 2016. All studies providing clear information on ADRs were included.
  
  
  RESULTS
  One hundred and one studies including 33 prospective cohort studies; 21 randomised controlled trials; 21 case series and 26 case reports met the inclusion criteria. These involved 6817 children and reported 4321 ADRs. The three ADRs experienced by the highest number of patients were weight gain, growth retardation and Cushingoid features with respective incidence rates of 21.1%, 18.1% and 19.4% of patients assessed for these ADRs. 21.5% of patients measured showed decreased bone density and 0.8% of patients showed osteoporosis. Biochemical HPA axis suppression was detected in 269 of 487 patients where it was measured. Infection was the most serious ADR, with twenty one deaths. Varicella zoster was the most frequent infection (9 deaths).
  
  
  CONCLUSIONS
  Weight gain, growth retardation and Cushingoid features were the most frequent ADRs seen when long-course oral corticosteroids were given to children. Increased susceptibility to infection was the most serious ADR.
authors.affiliation: Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, United Kingdom.
authors.forename: Fahad
authors.identifier: http://orcid.org/0000-0001-7482-0616
authors.initials: F
authors.lastname: Aljebab
authors.affiliation: Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, United Kingdom.
authors.forename: Imti
authors.initials: I
authors.lastname: Choonara
authors.affiliation: Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, United Kingdom.
authors.forename: Sharon
authors.initials: S
authors.lastname: Conroy
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000188:drug therapy; D003480:Cushing Syndrome / Q000139:chemically induced / Q000503:physiopathology*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000145:classification* / Q000503:physiopathology; D005260:Female; D006562:Herpes Zoster / Q000139:chemically induced / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010024:Osteoporosis / Q000139:chemically induced / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000503:physiopathology; D019141:Respiratory System Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015430:Weight Gain / Q000187:drug effects
chemical_list: D000305:Adrenal Cortex Hormones; D019141:Respiratory System Agents