Are steroids beneficial in the treatment of pneumonia?

From the Guidelines

Steroids are not recommended for routine use in patients with community-acquired pneumonia (CAP), except in cases of severe CAP or septic shock refractory to fluid resuscitation and vasopressor support, where they may be beneficial in reducing mortality and need for mechanical ventilation. The use of corticosteroids in CAP has been extensively studied, with conflicting results. However, the most recent and highest quality study, published in 2019 by the American Thoracic Society and Infectious Diseases Society of America, recommends against the routine use of corticosteroids in adults with nonsevere CAP, and suggests against their use in adults with severe CAP, except in cases of septic shock refractory to fluid resuscitation and vasopressor support 1.

Some studies have shown that corticosteroids may be beneficial in reducing mortality and need for mechanical ventilation in patients with severe CAP, particularly when used early in the disease course, ideally within 24-48 hours of hospital admission 1. However, these findings are not consistent across all studies, and the use of corticosteroids in CAP remains a topic of debate.

It is also important to note that corticosteroids should be used cautiously in patients with diabetes, as they can raise blood glucose levels. Additionally, corticosteroids may not be beneficial in patients with viral pneumonia, except in cases of COVID-19, where they have been shown to reduce mortality in patients requiring oxygen or mechanical ventilation 1.

In terms of specific dosing, methylprednisolone 0.5 mg/Kg IV every 12 hours for 5 days, or prednisone 50 mg daily, may be adequate for patients with severe CAP or septic shock refractory to fluid resuscitation and vasopressor support. However, the optimal dosing and duration of corticosteroid therapy in CAP remains unclear, and further studies are needed to determine the best approach.

Key points to consider when using corticosteroids in CAP include:

• They are not recommended for routine use in patients with nonsevere CAP
• They may be beneficial in reducing mortality and need for mechanical ventilation in patients with severe CAP or septic shock refractory to fluid resuscitation and vasopressor support
• They should be used cautiously in patients with diabetes
• They may not be beneficial in patients with viral pneumonia, except in cases of COVID-19
• The optimal dosing and duration of corticosteroid therapy in CAP remains unclear.

From the Research

Benefits of Steroids in Pneumonia

• The use of steroids in pneumonia treatment has been evaluated in several studies, with some indicating potential benefits in specific cases 2, 3, 4.
• Steroids may help modulate the immune system's response to pneumonia, potentially reducing inflammation and tissue damage 5, 6.
• Some studies suggest that steroids can improve oxygenation, reduce the need for mechanical ventilation, and decrease the rate of relapse in severe pneumonia 3, 4.

Limitations and Risks of Steroid Use

• The current evidence does not support the routine use of steroids as a standard treatment for pneumonia, due to the risk of adverse effects such as hyperglycemia, superinfections, and increased length of stay 2, 6.
• Steroid use may not be beneficial for all patients with pneumonia, and may even be harmful in some cases, particularly in those with mild-to-moderate pneumonia or viral infections 2, 6.
• The decision to use steroids in pneumonia treatment should be made on a case-by-case basis, taking into account the individual patient's condition, severity of illness, and potential risks and benefits 4.

Precision Medicine Approach

• A biomarker-guided, precision medicine approach to corticosteroid treatment may help identify patients who are most likely to benefit from adjunctive steroid therapy 5.
• This approach aims to give steroids at the appropriate dose and time, and only to patients with exaggerated inflammation, in order to minimize risks and maximize benefits 5.

Recent Findings

• A recent study found that corticosteroid treatment may be beneficial for patients with community-acquired pneumonia who have septic shock and/or a high inflammatory response and require invasive mechanical ventilation 4.
• However, the evidence is not strong enough to make definitive recommendations, and further research is needed to fully understand the role of steroids in pneumonia treatment 3, 6.