From the Guidelines
Corticosteroids are not recommended for routine use in patients with influenza pneumonia, as their use may be harmful in this specific condition. The American Thoracic Society and Infectious Diseases Society of America guideline 1 suggests not routinely using corticosteroids in adults with severe influenza pneumonia, citing a conditional recommendation with low quality of evidence. Additionally, a meta-analysis of predominantly small retrospective studies suggests that mortality may be increased in patients who receive corticosteroids for influenza pneumonia 1.
The standard treatment for patients with severe influenza pneumonia requiring hospitalization should focus on antiviral medications such as oseltamivir (Tamiflu) at 75mg twice daily for 5-10 days, with longer durations considered for critically ill patients. The Infectious Diseases Society of America guidelines 1 also recommend 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.
Some key points to consider in the management of influenza pneumonia include:
- The use of antiviral medications as the primary treatment
- The potential harm of corticosteroids in influenza pneumonia, including increased viral shedding, delayed viral clearance, and increased risk of secondary infections
- The importance of supportive care, including oxygen therapy, fluid management, and treatment of any bacterial co-infections
- The consideration of corticosteroids only in patients with other compelling indications, such as exacerbation of underlying asthma or COPD triggered by influenza, where the benefits may outweigh the risks. In these cases, the lowest effective dose should be used for the shortest duration possible 1.
From the Research
Steroids in Influenza Pneumonia
- The use of corticosteroids in patients with influenza has been associated with significantly higher mortality and higher incidence of nosocomial infection 2, 3, 4, 5, 6
- A meta-analysis of 19 studies found that corticosteroid therapy was associated with significantly higher mortality (OR 1.53,95% CI [1.16,2.01]) and incidence of nosocomial infection (OR 3.15,95% CI [1.54,6.45]) 4
- Another study found that corticosteroid therapy was associated with increased mortality (odds ratio 3.90,95% confidence interval 2.31 to 6.60) and increased odds of hospital-acquired infection (pooled OR 2.74,95% CI 1.51 to 4.95) 5, 6
- The evidence suggests that the use of corticosteroids in patients with influenza pneumonia may be harmful, and their use should be restricted to very selected cases and in the setting of clinical trials 3
- The current data do not support the routine use of corticosteroids in patients with influenza severe pneumonia or ARDS, and more high-quality research is needed to determine the effectiveness of corticosteroids for people with influenza 4, 5, 6
Key Findings
- Corticosteroids are associated with increased mortality and hospital-acquired infection in patients with influenza pneumonia
- The evidence is of low quality with potential confounding by indication a major concern
- High doses of corticosteroids (> 40 mg methylprednisolone per day) are commonly used, but the effect of dose on outcome is unclear
- More research is needed to determine the effectiveness of corticosteroids for people with influenza 5, 6