From the Guidelines
Corticosteroids are not routinely recommended for pneumonia in a hospital setting, except in cases of severe community-acquired pneumonia with significant inflammation or septic shock, or COVID-19 pneumonia requiring oxygen. For severe community-acquired pneumonia with significant inflammation or septic shock, intravenous dexamethasone 6mg daily for 5-10 days or methylprednisolone 0.5-1mg/kg every 12 hours for 5-7 days may be considered, as suggested by the IDSA/ATS 2019 guideline 1. The benefit of corticosteroids comes from reducing excessive inflammatory response that can damage lung tissue, but this must be balanced against potential risks including hyperglycemia, secondary infections, and delayed viral clearance, as noted in a meta-analysis of corticosteroid use in CAP patients 1. The decision to use steroids should be individualized based on pneumonia severity, underlying conditions, and the specific pathogen if known, with consideration of the potential benefits and harms, as discussed in a review of intensive care management of COVID-19 1. Early initiation of steroids (within 24-48 hours of admission) appears most beneficial in appropriate cases, but the routine use of corticosteroids in viral severe acute respiratory infections, including COVID-19, is not recommended without further data, as stated in a review of COVID-19 management 1. Some studies suggest that corticosteroids may be beneficial in severe CAP, but the evidence is not consistent, and the use of corticosteroids should be guided by the severity of the disease and the presence of septic shock, as suggested by a meta-analysis of severe CAP patients 1. In general, the use of corticosteroids in pneumonia should be guided by the principles of minimizing harm and maximizing benefit, with careful consideration of the potential risks and benefits, as emphasized in a review of COVID-19 treatment 1.
From the Research
Indications for Steroids in Pneumonia
- The use of corticosteroids (steroids) in pneumonia is a topic of ongoing debate, with some studies suggesting potential benefits and others highlighting limitations and risks 2, 3.
- In severe pneumonia, steroids have been proposed as an adjunctive therapy to regulate the inflammatory response and prevent tissue damage, although large randomized controlled trials are lacking to fully establish their efficacy and safety 2.
- A study from 1995 found that low-dose methylprednisolone combined with antibiotics was effective in treating aspiration pneumonia, showing improvements in clinical parameters such as CRP levels, neutrophil elastase, body temperature, and pneumonia score 4.
Current Guidelines and Practices
- Current guidelines for managing pneumonia in critically ill patients emphasize the importance of appropriate diagnosis, early initiation of antimicrobial treatment, and identification of the underlying causative pathogen 5.
- The use of steroids in pneumonia is not universally recommended and is typically considered on a case-by-case basis, taking into account the severity of the disease, the patient's immune status, and the risk of potential side effects 3, 5.
- A recent review highlights the role of antibiotics and steroids in managing respiratory diseases, including pneumonia, and discusses the potential benefits and drawbacks of their use, including the risk of antibiotic resistance and the need for careful consideration of treatment strategies 6.
Evidence and Controversies
- The evidence for the use of steroids in pneumonia is not conclusive, with some studies showing promising results and others raising concerns about the potential for adverse effects, such as immunosuppression and superinfections 2, 3.
- Further research is needed to fully understand the role of steroids in pneumonia and to establish clear guidelines for their use in clinical practice 2, 5.