From the Guidelines
Corticosteroids should not be routinely used in most cases of pneumonia, but may be considered in specific patient populations, such as those with severe community-acquired pneumonia, septic shock, or COVID-19 pneumonia requiring oxygen, as they may reduce mortality and morbidity. The use of corticosteroids in pneumonia is a complex issue, and the decision to use them should be individualized based on severity, underlying conditions, and risk factors. According to the American Thoracic Society and Infectious Diseases Society of America guidelines 1, corticosteroids are not recommended for routine use in adults with nonsevere community-acquired pneumonia (CAP), but may be considered in adults with severe CAP or septic shock.
The benefits of corticosteroids in pneumonia include reducing excessive inflammatory responses that can damage lung tissue during severe infections, shortening hospital stay, and reducing the need for mechanical ventilation 1. However, they also carry risks, including hyperglycemia, secondary infections, and delayed viral clearance. A meta-analysis of systemic corticosteroid use in COVID-19 patients found that corticosteroids did not reduce the risk of mortality, but may have reduced the duration of fever 1.
In terms of specific dosing, methylprednisolone (0.5-1 mg/kg/day) or dexamethasone (6 mg daily) for 5-7 days may be considered for severe community-acquired pneumonia with significant inflammation or septic shock. For COVID-19 pneumonia requiring oxygen, dexamethasone 6 mg daily for up to 10 days has shown mortality benefits. Patients receiving steroids should be monitored for blood glucose elevations, electrolyte imbalances, and signs of secondary infections during treatment.
Some key points to consider when deciding whether to use corticosteroids in pneumonia include:
- Severity of illness: Corticosteroids may be more beneficial in patients with severe pneumonia or septic shock.
- Underlying conditions: Patients with underlying conditions, such as diabetes or immunosuppression, may be at higher risk for complications from corticosteroids.
- Risk factors: Patients with risk factors, such as older age or comorbidities, may be at higher risk for complications from pneumonia and may benefit from corticosteroids.
- Type of pneumonia: Corticosteroids may be more beneficial in patients with community-acquired pneumonia or COVID-19 pneumonia, rather than other types of pneumonia.
Overall, the decision to use corticosteroids in pneumonia should be made on a case-by-case basis, taking into account the individual patient's severity of illness, underlying conditions, and risk factors.
From the Research
Role of Steroids in Pneumonia
- Steroids, such as corticosteroids, can influence immune regulation, carbohydrate metabolism, protein catabolism, electrolyte balance, and stress response in patients with pneumonia 2.
- The benefits of corticosteroids for patients with pneumonia remain unclear, but some studies suggest that they can accelerate the resolution of symptoms, decrease the rate of relapse, and improve oxygenation in severe pneumonia 2.
- Steroids can also reduce the need for mechanical ventilation in severe pneumonia, but there is no significant difference in the time to discharge from the intensive care unit (ICU) between treatment groups 2.
Types of Steroids Used in Pneumonia
- Methylprednisolone is a type of steroid that has been studied in the treatment of severe community-acquired pneumonia (CAP) and COVID-19 pneumonia 3, 4.
- Dexamethasone is another type of steroid that has been used in the treatment of COVID-19 pneumonia, and some studies suggest that it may be more effective than methylprednisolone in severe forms of the disease 5.
- Hydrocortisone is also a type of steroid that has been used in the treatment of COVID-19 pneumonia, but its effectiveness is not as well-studied as dexamethasone and methylprednisolone 6.
Efficacy and Safety of Steroids in Pneumonia
- Some studies suggest that steroids can reduce the need for mechanical ventilation and improve clinical outcomes in patients with severe pneumonia, but the evidence is limited and more research is needed to confirm these findings 3, 4.
- Steroids can also improve oxygenation and reduce the rate of relapse in patients with pneumonia, but the benefits may vary depending on the type and severity of the disease 2.
- The safety of steroids in pneumonia is generally good, but there is a risk of adverse events, such as hyperglycemia and hypertension, especially with high-dose therapy 3, 4.
Biomarkers for Steroid Treatment in Pneumonia
- Inflammatory biomarkers, such as C-reactive protein and procalcitonin, can be used to assess the severity of pneumonia and guide treatment decisions, including the use of steroids 6.
- However, more research is needed to determine the role of biomarkers in predicting the response to steroid treatment and optimizing dosing regimens 6.