From the Guidelines
Prednisone should not be routinely used in adults with nonsevere community-acquired pneumonia (CAP), but may be considered in cases of severe CAP or specific conditions such as Pneumocystis pneumonia (PCP) under the guidance of a healthcare provider. The use of corticosteroids like prednisone in pneumonia is a topic of ongoing debate, with evidence suggesting potential benefits in reducing inflammation and improving recovery time in certain cases, but also risks of impairing the immune system and worsening infection if used inappropriately 1.
Key Considerations
- The American Thoracic Society and Infectious Diseases Society of America recommend against the routine use of corticosteroids in adults with nonsevere CAP, citing high-quality evidence that shows no significant benefit in mortality or organ failure 1.
- For severe CAP, the recommendation is to not routinely use corticosteroids, based on moderate-quality evidence, although some studies suggest a potential mortality benefit, particularly in cases with significant inflammation 2, 1.
- In cases of PCP, especially in HIV patients, higher doses of prednisone (40-60mg daily, tapered over 21 days) are often recommended alongside antibiotics to reduce the risk of respiratory failure and improve outcomes 2.
Treatment Decisions
Treatment decisions regarding the use of prednisone in pneumonia should be made on a case-by-case basis, taking into account the severity of the pneumonia, the presence of underlying conditions, and the potential risks and benefits of corticosteroid therapy. Healthcare providers should carefully evaluate each patient's specific situation and consider the latest evidence-based guidelines. The goal is to balance the potential benefits of reducing inflammation and improving recovery time with the risks of impairing the immune system and potentially worsening the infection.
Evidence Base
The evidence base for the use of prednisone in pneumonia includes several studies and guidelines, with the most recent and highest-quality evidence suggesting a cautious approach to the use of corticosteroids in CAP 1. The guidelines from the American Thoracic Society and Infectious Diseases Society of America provide a comprehensive review of the evidence and recommendations for practice 1.
From the FDA Drug Label
Corticosteroids, including prednisone tablets, suppress the immune system and increase the risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens Corticosteroids can: • Reduce resistance to new infections • Exacerbate existing infections • Increase the risk of disseminated infections • Increase the risk of reactivation or exacerbation of latent infections • Mask some signs of infection
The use of prednisone may increase the risk of infection, including pneumonia, due to its immunosuppressive effects. Patients taking prednisone should be monitored for the development of infection and the dosage should be adjusted as needed 3.
From the Research
Prednisone and Pneumonia
- The use of corticosteroids, such as prednisone, in the treatment of pneumonia is a topic of ongoing debate 4, 5.
- Studies have shown that corticosteroids may not have a significant impact on survival in patients with severe community-acquired pneumonia, and may even be associated with harmful effects such as invasive aspergillosis and superinfections 4, 5.
- The current evidence suggests that corticosteroids are only recommended in specific cases, such as Pneumocystis jiroveci pneumonia in HIV-infected patients, and are not recommended for use in influenza 4.
- Adverse effects, such as hyperglycemia and increased length-of-stay, are common in patients treated with corticosteroids for pneumonia 4, 5.
- Further studies are needed to identify subgroups of patients with severe community-acquired pneumonia who may benefit from corticosteroid therapy 4, 5.
- It is worth noting that the studies provided do not specifically mention prednisone, but rather corticosteroids in general, and that the use of prednisone in pneumonia treatment should be guided by the current evidence and clinical guidelines.
- Other treatments, such as antibiotics, may be more effective in treating uncomplicated community-acquired pneumonia, as shown in a study comparing high-dose penicillin and amoxicillin 6.