Is prednisone an antibiotic?

In this article:

• Is prednisone an antibiotic?
• Unpacking prednisone
• When is it prescribed?
• Understanding the connection
• The bottom line

In this article

• Is prednisone an antibiotic?
• Unpacking prednisone
• When is it prescribed?
• Understanding the connection
• The bottom line

Prednisone, also available under several brand names, is an FDA-approved corticosteroid medication used to reduce inflammation and suppress the immune system in patients with conditions like asthma, arthritis, and autoimmune disorders like multiple sclerosis. It works by mimicking cortisol, a hormone naturally produced by your adrenal glands, to reduce inflammation throughout the body. Despite its effectiveness in treating many inflammatory conditions, prednisone is not an antibiotic and does not fight bacterial infections.

Is prednisone an antibiotic?

While corticosteroids and antibiotics are commonly prescribed and are sometimes even used together, prednisone is not an antibiotic. Antibiotics are prescribed to kill the bacteria that cause infections like strep throat, urinary tract infections, and pneumonia. Prednisone, on the other hand, is a corticosteroid, used for periods of time to reduce inflammation and suppress immune system activity.

Michael Genovese, MD, Chief Medical Advisor at Ascendant New York, outlines the difference clearly: “Antibiotics directly kill bacteria and allow the bacteria to be cleared by the body to treat infections. Prednisone is a strong corticosteroid that reduces inflammation throughout the body by suppressing the immune system to help manage autoimmune diseases or inflammatory conditions like asthma or lupus.”

Corticosteroids work by mimicking cortisol, a hormone your body naturally produces, to regulate inflammation and immune responses, which in turn helps decrease swelling and pain. Because of this, corticosteroids are typically used to treat autoimmune conditions, severe allergic reactions, and various inflammatory diseases that cause an overactive immune response, but they do not treat bacterial infections.

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Unpacking prednisone: What it actually is

While antibiotics work to kill bacteria and prevent further growth, prednisone adjusts how your immune system responds to threats, thereby reducing inflammation. 

To do this, prednisone binds to glucocorticoid receptors within cells, thereby slowing the production of inflammatory chemicals called cytokines, decreasing the activity of immune cells, and preventing blood vessels from dilating during inflammatory responses. Together, these activities help manage symptoms such as swelling, pain, and tissue damage associated with inflammatory conditions.

“Prednisone is a powerful anti-inflammatory and immunosuppressive drug, chemically mimicking cortisol, a natural hormone produced by the adrenal glands,” explains Brian Honeyman, MD, Ph.D., Clinical Advisor at iRely Recovery. This means that prednisone cannot treat bacterial infections on its own. In fact, because prednisone suppresses the immune system, taking it during an active bacterial infection without appropriate antibiotic treatment could potentially allow the infection to worsen. 

Common prednisone side effects include:

• Behavior disturbances, including anxiety, agitation, and depression
• Hyperglycemia (elevated blood sugar)
• Acne
• Headache
• Increased appetite
• Insomnia
• Weight gain
• High blood pressure
• Fluid retention
• Decreased potassium and calcium levels
• Adrenal gland issues
• Eye problems, including cataracts or glaucoma
• Bone problems, including osteoporosis
• Growth suppression in children.

Serious side effects warranting immediate medical attention include:

• Flu-like symptoms, including fever, chills, cough, sore throat, and body aches
• Depression, trouble sleeping, or unusual thoughts, feelings, or behaviors
• Severe stomach pain, nausea, vomiting, or red or black stools
• Chest pain or shortness of breath
• Rapid weight gain or swelling
• Changes in vision, eye pain, or headache
• Skin changes or growths
• Muscle weakness or pain
• Seizures
• Bone pain, fractures, or a decrease in height
• Dark freckles, skin color changes, coldness, weakness, tiredness, nausea, vomiting, or weight loss
• Allergic reactions, including itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, and trouble breathing

Seek medical advice before taking prednisone if you have one of the following conditions:

• Cushing’s syndrome
• Diabetes or high blood sugar
• Glaucoma
• Cardiovascular disease
• High blood pressure
• Systemic fungal infections
• Active infections, including viral infections like chickenpox, measles, and herpes
• Liver or kidney disease
• Myasthenia gravis
• Osteoporosis
• Seizure disorders
• Gastrointestinal problems
• Thyroid disease
• Pregnant, trying to get pregnant, or breastfeeding

Possible drug interactions include:

• Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen
• Diuretics
• Diabetes medications
• Estrogens
• Blood thinners like warfarin

Prednisone may also interfere with certain vaccines, so check with your provider before getting vaccinated while taking prednisone.

When and why doctors prescribe prednisone

Healthcare providers prescribe prednisone for a variety of inflammatory and autoimmune conditions, including severe allergic reactions, asthma attacks, and flare-ups of autoimmune diseases such as rheumatoid arthritis, lupus, or inflammatory bowel disease.

According to Dr. Honeyman, “prednisone is the appropriate choice when the primary disease process involves excessive or harmful inflammation that needs to be suppressed to prevent organ damage or significant patient distress.”

This includes some cancer treatment protocols, preventing organ rejection after transplantation, or even treating certain skin conditions like severe eczema or psoriasis. Prednisone can be used to aid in a range of conditions because it effectively reduces inflammation throughout the body. However, it also carries an increased risk of infection, especially with higher doses of prednisone.

Because corticosteroids suppress the immune system, taking them without the appropriate medication to target an infection could allow that infection to spread and become more dangerous. Therefore, it’s important to always take prednisone as prescribed and complete any antibiotic courses as directed, even if you start feeling better.

Additionally, healthcare professionals sometimes prescribe prednisone in addition to antibiotics, as it can help reduce the inflammation caused by an infection. For example, in cases of severe pneumonia, doctors may prescribe a short course of prednisone to reduce lung inflammation, in conjunction with the necessary antibiotics to kill the bacteria.

Why the confusion?

Because both medications are often prescribed for common, acute illnesses, it’s not entirely surprising that there’s room for confusion. Due to symptom overlap and co-prescribing, it may not be clear to patients which medication is doing what, and mix up the two.

For example, as a patient, if you have a fever, fatigue, or respiratory problems, you don’t necessarily know whether the underlying cause is an infection that requires antibiotics or inflammation that would warrant steroids.

Additionally, “a patient with bronchitis might receive an antibiotic if a bacterial cause is suspected, but if they have significant airway swelling, prednisone is often added to alleviate the inflammation. Patients then mistakenly conflate the two medications as both being ‘infection fighters’,” says Dr. Honeyman.

Dr. Genovese adds that while both medications can offer relief for symptoms, “it is important for doctors to clarify that the antibiotic targets the infection while prednisone treats the swelling and pain that comes with the infection.” 

To help illustrate this to patients, Dr Honeyman uses a helpful analogy: “I explain that prednisone is like a firefighter that rapidly puts out the inflammation that is burning out of control, saving their lungs or airway. However, it also temporarily turns off the police force, their immune system. When the immune system is suppressed, the body is less able to fight off new infections or the one they already have. The antibiotic is the specialized force specifically tasked with killing the identified infection.”

The bottom line

While antibiotics target and treat bacterial infections, prednisone’s role is to calm overactive immune responses and reduce swelling in the body. While they are sometimes prescribed together and may both be used to treat similar conditions, including respiratory issues, they belong to different medication classes.

If your healthcare provider prescribes an antibiotic alongside prednisone, it likely means you have both an infection as well as inflammation that need to be addressed together, but the medications serve different purposes.

It’s important to note that using corticosteroids without medical supervision can be dangerous, so do not use prednisone leftover from a previous prescription to self-treat new symptoms. If you have questions about your medications or notice unusual symptoms while taking prednisone, seek professional medical advice immediately.