From the Guidelines
Corticosteroids should not be routinely used in adults with nonsevere community-acquired pneumonia (CAP), but may be considered in severe cases, particularly those with high inflammatory markers or requiring ICU admission, as they can reduce mortality, length of stay, and organ failure 1.
Key Considerations
- The use of corticosteroids in CAP should be individualized, taking into account the severity of the disease, the presence of comorbidities, and the potential risks and benefits of treatment.
- The preferred regimen for severe CAP is dexamethasone 6mg daily for 5-10 days or methylprednisolone 0.5-1mg/kg/day for 5-7 days, as these regimens have been shown to reduce mortality and improve outcomes in severe cases 1.
- Steroids should be used cautiously in patients with diabetes, as they can worsen glycemic control, and are generally not recommended for mild pneumonia or viral pneumonia without hypoxemia.
- Potential side effects of corticosteroids include hyperglycemia, increased infection risk, and gastrointestinal bleeding, so blood glucose monitoring is advised during treatment.
Benefits and Risks
- Corticosteroids can reduce mortality, length of stay, and organ failure in severe CAP, particularly in patients with high inflammatory markers or requiring ICU admission 1.
- However, they may also increase the risk of hyperglycemia, secondary infections, and other complications, particularly in patients with comorbidities or receiving high-dose steroids 1.
- The timing of steroid administration is important, with early use (within 36 hours of admission) appearing most beneficial in severe cases.
Clinical Decision-Making
- Clinicians should carefully weigh the potential benefits and risks of corticosteroid therapy in patients with CAP, taking into account the individual patient's clinical presentation, comorbidities, and disease severity.
- The use of corticosteroids should be guided by clinical judgment and evidence-based guidelines, with careful monitoring of patients for potential side effects and complications.
From the Research
Steroids in Pneumonia
- The use of steroids in pneumonia has been studied in various research papers, with some showing potential benefits and others highlighting limitations and controversies 2, 3, 4, 5, 6.
- A study published in 2011 found that glucocorticosteroids (GCs) may modulate the inflammatory response and offer benefits in patients with severe sepsis, but the effect of steroids on survival is debatable 2.
- Another study from 2011 assessed the efficacy and safety of corticosteroids in the treatment of pneumonia and found that they can accelerate the resolution of symptoms, but the evidence was not strong enough to make recommendations 3.
- A 2022 clinical trial investigated the use of low-dose methylprednisolone in critically ill patients with severe community-acquired pneumonia and found no significant difference in 60-day mortality between the treatment and placebo arms 4.
- A literature review from 2011 examined the use of steroids in severe pneumonia and found that the benefits of steroid use have not been proven by current literature, but ongoing investigations of anti-inflammatory molecules may represent a key point in severe infection management 5.
- A review from 2012 evaluated the potential benefits and adverse effects of adjunctive therapy with systemic steroids in patients with pneumonia and found that there are no data to support the well-tolerated use of systemic steroids as a standard of care in pneumonia 6.
Key Findings
- Steroids may modulate the inflammatory response in pneumonia, but their effect on survival is unclear 2, 3, 4.
- Corticosteroids can accelerate the resolution of symptoms and improve oxygenation in severe pneumonia, but the evidence is limited 3.
- The use of steroids in pneumonia is associated with potential adverse effects, such as hyperglycemia, superinfections, and increased length-of-stay 6.
- Large randomized controlled trials are needed to determine the benefits and risks of steroid use in pneumonia 5, 6.