What is the role of dexamethasone (corticosteroid) treatment in influenza pneumonia?

From the Guidelines

Dexamethasone treatment is not recommended for routine use in influenza pneumonia, as it may increase mortality in patients with influenza-associated pneumonia, according to a meta-analysis of predominantly small retrospective studies 1.

Role of Corticosteroids in Influenza Pneumonia

• The use of corticosteroids in influenza pneumonia is generally not recommended, unless clinically indicated for other reasons, such as septic shock refractory to fluid resuscitation and vasopressor use 1.
• A meta-analysis of patients with influenza pneumonia suggested that mortality may be increased in patients who receive corticosteroids 1.
• The IDSA/ATS 2019 guideline gives a strong conditional recommendation against routine use of adjunctive steroids in patients treated for CAP, including those with influenza pneumonia 1.

Exceptions to the Recommendation

• Corticosteroids may be beneficial in patients with severe CAP, including those with septic shock refractory to fluid resuscitation and vasopressor use, especially in those with an elevated CRP >150 mg/L 1.
• However, this benefit is not seen in patients with viral CAP, such as influenza pneumonia, where corticosteroid use has been associated with increased mortality 1.

Clinical Practice Guidelines

• The Infectious Diseases Society of America recommends against the use of corticosteroid adjunctive therapy for the treatment of adults or children with suspected or confirmed seasonal influenza, unless clinically indicated for other reasons 1.

From the Research

Role of Dexamethasone in Influenza Pneumonia

• Dexamethasone, a corticosteroid, has been studied for its potential role in treating influenza pneumonia, with some studies suggesting it may improve outcomes [(2,3,4,5)].
• A study published in JAMA found that low-dose corticosteroids, including dexamethasone, can reduce mortality in patients with severe pulmonary infections, including influenza 2.
• Another study published in Scientific Reports found that sequential treatment with high-dose steroids and short-course oral glucocorticoids may be helpful in reducing the tracheal intubation rate and mortality rate in patients with severe influenza virus-associated pneumonia 3.
• A study published in Frontiers in Microbiology found that liposomal dexamethasone reduced A/H1N1 influenza-associated morbidity in mice 4.
• However, a study published in the World Journal of Critical Care Medicine found that corticosteroids failed to demonstrate any beneficial effects in the treatment of patients with severe influenza infection and may even increase overall mortality 6.

Potential Benefits and Risks

• The potential benefits of dexamethasone treatment in influenza pneumonia include reduced mortality, improved lung immunopathology, and decreased incidence of acute respiratory distress syndrome [(2,3,4,5)].
• However, the use of dexamethasone may also be associated with risks such as hyperglycemia, gastrointestinal bleeding, neuropsychiatric disorders, muscle weakness, hypernatremia, and secondary infections 2.
• The optimal dosage and duration of dexamethasone treatment for influenza pneumonia are not well established and may vary depending on the severity of the infection and the individual patient's response [(3,6)].

Clinical Implications

• The use of dexamethasone in influenza pneumonia should be considered on a case-by-case basis, taking into account the severity of the infection, the patient's underlying health status, and the potential benefits and risks of treatment [(2,3,6)].
• Further research is needed to fully understand the role of dexamethasone in treating influenza pneumonia and to establish evidence-based guidelines for its use [(2,3,4,5,6)].