From the Guidelines
Intravenous corticosteroids should not be routinely used in adults with nonsevere community-acquired pneumonia (CAP), but may be considered in patients with severe CAP or those requiring ICU admission, as they may reduce mortality, length of stay, and organ failure, although the evidence is moderate and not consistent across all studies. When considering the use of intravenous corticosteroids in pneumonia, it is essential to weigh the potential benefits against the risks, including hyperglycemia and possible higher secondary infection rates 1. The most commonly used regimens include methylprednisolone 0.5-1 mg/kg IV every 12 hours for 5-7 days or dexamethasone 6 mg IV daily for 7-10 days, although the optimal dose and duration of treatment are not well established 1. Key considerations for the use of intravenous corticosteroids in pneumonia include:
- Patient severity: Corticosteroids may be more beneficial in patients with severe CAP or those requiring ICU admission 1.
- Inflammatory markers: Patients with high inflammatory markers may benefit from corticosteroid therapy 1.
- Comorbidities: Patients with certain comorbidities, such as uncontrolled diabetes, active tuberculosis, or fungal infections, should be treated with caution 1.
- Monitoring: Blood glucose monitoring is essential during treatment with corticosteroids, as they can cause hyperglycemia 1. Overall, the decision to use intravenous corticosteroids in pneumonia should be made on a case-by-case basis, taking into account the individual patient's risk factors, severity of illness, and potential benefits and risks of treatment 1.
From the Research
IV Steroids in Pneumonia
- The use of IV steroids in pneumonia has been studied in various contexts, including COVID-19 and community-acquired pneumonia 2, 3, 4, 5, 6.
- A study comparing methylprednisolone and dexamethasone in COVID-19 patients found that methylprednisolone improved inflammatory markers and reduced the length of stay in the intensive care unit 2.
- Another study found that prolonged, higher-dose methylprednisolone did not reduce mortality at 28 days compared to conventional dexamethasone in COVID-19 pneumonia 3.
- A randomized controlled trial of low-dose methylprednisolone in critically ill patients with severe community-acquired pneumonia found no significant difference in 60-day mortality between the methylprednisolone and placebo arms 4.
- A retrospective cohort study of nonintubated patients with severe COVID-19 pneumonia found that methylprednisolone was associated with reduced need for mechanical ventilation and less-intensive care resource utilization without excess complications 5.
- A comparative study of dexamethasone and methylprednisolone in COVID-19 pneumonia found that both steroids were efficient in the management of mild, moderate, and severe COVID-19 pneumonia, with a clear superiority of dexamethasone especially in severe forms 6.
Key Findings
- Methylprednisolone may improve inflammatory markers and reduce the length of stay in the intensive care unit in COVID-19 patients 2.
- Dexamethasone may be superior to methylprednisolone in severe COVID-19 pneumonia 6.
- Low-dose methylprednisolone may not reduce mortality in critically ill patients with severe community-acquired pneumonia 4.
- Methylprednisolone may reduce the need for mechanical ventilation and less-intensive care resource utilization in nonintubated patients with severe COVID-19 pneumonia 5.