For moderate illness (eg fever, infection requiring antibiotics, surgical procedure under local anaesthetic), usual oral steroid dose can be doubled up. In patients with suspected or proven COVID-19 infection, high doses of gluccocorticoid supplementation (equivalent to hydrocortisone 20 mg four times daily) should be used.

To cover severe illness, eg persistent vomiting, pneumonia, trauma or acute surgery, patients should receive an initial bolus of 100 mg IV hydrocortisone followed by 50 mg (IM or IV) hydrocortisone 6-hourly or 200 mg / 24 hour IV infusion until resolution of the illness.

For moderate elective procedures or investigations, eg endoscopy or angiography, patients should receive a single dose of 100 mg hydrocortisone before the procedure.