Rational Corticosteroid Use: An Evidence-Based Narrative Review of Steroid Stewardship to Enhance Patient Safety Across Healthcare Settings.

Corticosteroids are potent medicines that are commonly used to treat inflammation, autoimmune conditions, and acute illnesses. Overuse or misuse can cause serious side effects like high blood sugar, slow growth, mood swings, infections, and adrenal insufficiency. This narrative review examines the need for structured steroid stewardship programs (SSPs) to optimize patient therapeutic outcomes. We derive the evidence from real-world prescribing studies, pharmacovigilance reports, and stewardship intervention trials published between 2015 and 2025, with emphasis on post-marketing safety data. Worldwide, 5-10% of hospitalized patients get systemic steroids every year. In India, the percentage of patients who get them is between 2% and 34%. Adverse effects occur in nearly 50% of the patients on long-term use. Effective stewardship components include multidisciplinary teams, prescription audits, standardized tapering protocols (10-20% dose reduction every 7-15 days), handheld steroid emergency cards, and educating patients on "sick day rules". The patient-centered outcomes, including quality of life, treatment satisfaction, and adrenal crisis prevention, remain underreported. To ensure long-term safety and sustainability, stronger collaborative initiatives between healthcare providers and policymakers are essential. We propose a five-component stewardship framework with potential safety indicators: (1) steroid emergency cards, (2) prescription audits by pharmacists, (3) standardization of tapering protocols, (4) patient education on sick-day rules, and (5) monitoring of outcomes including adrenal crisis rates and hyperglycemic events. The framework is intended to support safer corticosteroid use and improve medication safety, but its feasibility and effectiveness need to be evaluated prospectively across different healthcare settings.