From the Guidelines
Intramuscular (IM) steroids are not routinely recommended for treating pneumonia. The standard treatment for pneumonia typically involves antibiotics targeted at the causative organism, such as amoxicillin, azithromycin, or doxycycline, depending on the suspected pathogen and local resistance patterns. Corticosteroids, including IM forms like dexamethasone or methylprednisolone, are generally reserved for specific situations in pneumonia management, such as severe community-acquired pneumonia with significant inflammation or pneumonia associated with certain conditions like COPD exacerbations or Pneumocystis pneumonia.
Key Points to Consider
- When steroids are indicated, they're typically given as a short course (5-7 days) and often administered intravenously in hospitalized patients rather than via the IM route.
- The rationale for limiting steroid use is that while they can reduce inflammation, they may also impair immune function and potentially worsen infection if used inappropriately.
- Additionally, steroids carry significant side effects including hyperglycemia, increased risk of secondary infections, and gastrointestinal bleeding.
- For most uncomplicated pneumonia cases, supportive care with appropriate antibiotics, adequate hydration, and rest remains the cornerstone of treatment.
Evidence-Based Recommendation
The most recent and highest quality study, 1, provides a strong recommendation against the routine use of corticosteroids in adults with nonsevere community-acquired pneumonia (CAP), and a conditional recommendation against their use in adults with severe CAP. This guideline is based on high-quality evidence and should be followed in clinical practice to minimize morbidity, mortality, and improve quality of life for patients with pneumonia.
From the Research
Use of IM Steroids in Pneumonia
- The use of intramuscular (IM) steroids in treating pneumonia is a topic of ongoing debate, with some studies suggesting benefits and others raising concerns about potential harm 2, 3.
- A randomized clinical trial published in JAMA in 2015 found that the use of methylprednisolone in patients with severe community-acquired pneumonia and high inflammatory response decreased treatment failure compared to placebo 2.
- However, another study published in Current Opinion in Infectious Diseases in 2012 noted that steroids had no impact on survival in patients with pneumonia and may even have potential harmful effects, such as hyperglycemia and superinfections 3.
- A review of pulmonary diseases and corticosteroids published in the Indian Journal of Pediatrics in 2008 highlighted the controversy surrounding the use of corticosteroids in various pulmonary conditions, including pneumonia, and emphasized the need to weigh the benefits against potential detrimental effects 4.
- More recent research, including a review published in JAMA in 2024, suggests that low-dose corticosteroids may be beneficial in reducing mortality in critically ill adults with severe pulmonary infections, including community-acquired pneumonia 5.
- Another study published in Critical Care in 2011 noted that while corticosteroids should not be routinely used as adjuvant therapy for severe community-acquired pneumonia, there is sufficient equipoise to continue studying their use 6.
Key Findings
- The use of IM steroids in pneumonia may be beneficial in reducing treatment failure and mortality in certain patient populations, such as those with severe community-acquired pneumonia and high inflammatory response 2, 5.
- However, the potential benefits of IM steroids must be carefully weighed against the risks of adverse effects, such as hyperglycemia and superinfections 3, 4.
- Further research is needed to fully understand the role of IM steroids in treating pneumonia and to identify patient populations that may benefit from this therapy 2, 6.