From the Guidelines
Hydrocortisone is used in severe pneumonia, particularly in cases of septic shock or severe community-acquired pneumonia, to reduce inflammation and improve outcomes, as evidenced by a mortality reduction and shortened hospital stay in patients with severe pneumonia 1. The use of hydrocortisone in pneumonia is supported by several studies, including a 2018 guideline that suggests corticosteroids, such as hydrocortisone, can reduce mortality and improve outcomes in patients with severe pneumonia 1.
Key Points
- Hydrocortisone works by suppressing excessive inflammatory responses that can damage lung tissue and worsen respiratory function.
- The medication is not recommended for mild to moderate pneumonia without shock, as it may impair immune function and potentially worsen infection, as suggested by a 2019 clinical practice guideline 1.
- Side effects of hydrocortisone include hyperglycemia, increased risk of secondary infections, gastrointestinal bleeding, and fluid retention.
- Hydrocortisone should be used cautiously in patients with diabetes, active infections, or gastrointestinal bleeding, and blood glucose levels should be monitored during treatment.
Dosage and Administration
For patients with septic shock, the recommended dose of hydrocortisone is typically 200-300 mg daily, divided into three or four doses or given as a continuous infusion, usually for 5-7 days with gradual tapering 1.
Special Considerations
The use of hydrocortisone in pneumonia due to influenza may be associated with increased mortality, and its use in this context should be approached with caution 1. Overall, the use of hydrocortisone in severe pneumonia, particularly in cases of septic shock or severe community-acquired pneumonia, can improve outcomes and reduce mortality, but its use should be carefully considered and monitored due to potential side effects and complications 1.
From the Research
Use of Hydrocortisone in Pneumonia
- Hydrocortisone is used in the treatment of pneumonia due to its anti-inflammatory and immunomodulatory effects 2, 3, 4.
- Studies have shown that hydrocortisone can decrease mortality among patients with severe community-acquired pneumonia 2, 3, 4.
- The use of hydrocortisone has been associated with a lower risk of death, reduced need for mechanical ventilation, and shorter duration of intensive care unit stay 2, 3, 4.
Mechanism of Action
- Hydrocortisone works by reducing systemic inflammation and modulating the immune response, which can lead to earlier resolution of pneumonia and a reduction in sepsis-related complications 3, 5.
- The anti-inflammatory effects of hydrocortisone can also improve oxygenation and reduce the need for mechanical ventilation in severe pneumonia 6.
Clinical Evidence
- A phase 3, multicenter, double-blind, randomized, controlled trial found that hydrocortisone reduced mortality by 28 days in patients with severe community-acquired pneumonia 2.
- A systematic review and meta-analysis found that hydrocortisone was associated with a lower rate of all-cause mortality and improved pneumonia outcomes among patients hospitalized with severe community-acquired pneumonia 4.
- Another study found that corticosteroid treatment, including hydrocortisone, may be beneficial for patients with community-acquired pneumonia who have septic shock and/or a high inflammatory response and requirement for invasive mechanical ventilation 5.