We agree with Dr Christopeit et al on the need for further research into the role of corticosteroids in the management of neutropenic patients with sepsis ( Christopeit et al , 2011 ). In their own review ( Penack et al , 2011 ), they comment on the conflicting evidence for the use of low dose hydrocortisone in patients with severe sepsis and the paucity of evidence in patients with neutropenia or haematological malignancy. More recent meta-analyses of the subject using Bayesian analysis have been equally confusing with one review suggesting a high probability of reduced mortality with low dose corticosteroids without a concurrent increase in complications ( Moran et al , 2010 ) whilst a second study reported the opposite ( Kalil & Sun, 2010 ). Dr Cristopeit et al also point out the conflicting evidence from basic science on the potential benefits and harms from corticosteroids in patients with neutropenia. With such difficulties interpreting the evidence it is unsurprising that different professional bodies have produced conflicting consensus guidance. Our practice remains to use corticosteroids cautiously in patients with neutropenic septic shock. In practice, we continue to administer low dose hydrocortisone to all patients with septic shock who remain hypotensive despite adequate fluid resuscitation and remain unstable with escalating vasopressor requirements. In this small group of patients we believe that the benefits of earlier shock reversal and potential mitigation of the harm of high dose vasopressors warrant a short course of low dose hydrocortisone.