From the Guidelines
Corticosteroids are not routinely recommended for adults with community-acquired pneumonia (CAP), including both nonsevere and severe cases, due to the lack of consistent evidence showing a significant benefit in mortality, length of stay, or organ failure. The use of corticosteroids in CAP should be individualized, considering the severity of pneumonia, comorbidities, and risk factors for adverse effects 1. For hospitalized patients with CAP, the decision to use corticosteroids should be based on the presence of refractory septic shock or other specific conditions that may benefit from steroid therapy, as endorsed by the Surviving Sepsis Campaign recommendations 1.
Some key points to consider when deciding on corticosteroid use in CAP include:
- The potential benefits of corticosteroids, such as reducing inflammatory responses in the lungs and potentially decreasing time to clinical stability and length of hospital stay 1
- The potential risks of corticosteroids, including hyperglycemia, increased risk of secondary infections, and gastrointestinal bleeding 1
- The lack of consistent evidence showing a significant benefit of corticosteroids in CAP, including the results of randomized controlled trials and meta-analyses 1
- The importance of individualizing the decision to use corticosteroids based on patient-specific factors, such as pneumonia severity, comorbidities, and risk factors for adverse effects 1
In terms of specific corticosteroid regimens, hydrocortisone at a daily dose < 400 mg IV for 5-7 days may be considered in hospitalized patients with CAP, although this is based on a conditional recommendation with moderate quality of evidence 1. However, the most recent and highest-quality evidence suggests that corticosteroids should not be routinely used in adults with CAP, including both nonsevere and severe cases 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Steroids for Community-Acquired Pneumonia (CAP)
- The use of corticosteroids in CAP has been studied, with some evidence suggesting benefits in reducing time to clinical stability and length of hospital stay, particularly in severe cases 2.
- Current guidelines do not recommend routine use of corticosteroids for CAP, except in cases of refractory septic shock 2, 3.
- A systematic review and meta-analysis found that hydrocortisone was associated with a lower risk of all-cause mortality and improved outcomes in severe CAP, while other corticosteroids (dexamethasone, methylprednisolone, and prednisolone) did not show similar benefits 4.
- The choice of corticosteroid and patient selection are important considerations, with hyperglycemia being a common adverse effect of corticosteroid therapy in CAP 2.
- Further research is needed to define the ideal role of corticosteroids in CAP and to investigate safety concerns, such as the potential impact on CAP-related rehospitalizations 2.
Recommended Steroids
- Hydrocortisone may be considered for use in severe CAP, given its association with reduced mortality and improved outcomes 4.
- Other corticosteroids, such as dexamethasone, methylprednisolone, and prednisolone, may not provide the same benefits in CAP 4.
Important Considerations
- Patient selection and individualized treatment approaches are crucial in determining the use of corticosteroids in CAP 2, 3.
- The potential benefits and risks of corticosteroid therapy should be carefully weighed, taking into account factors such as disease severity, patient comorbidities, and local antimicrobial susceptibility patterns 2, 5.