Steroids For CAP Patients Who Are Admitted
Current data demonstrate that for adult patients with severe community-acquired pneumonia corticosteroids reduce morbidity and mortality (1-3). For pediatric patients and adults with non-severe CAP who are admitted to the hospital, corticosteroids appear to reduce morbidity, but not mortality.
The use of corticosteroids has also demonstrated to cause a reduction in early clinical failures, time to clinical cure, length of overall hospital stay, total ICU days, development of respiratory failure or shock, and rates of pneumonia complications in adults with severe CAP.
It must be noted that the data for children is based on small studies and the mortality event rate was low.
Most adult studies used a corticosteroid dose equivalent to 40 – 50 mg of prednisone/day for 7 days.
A December, 2017 Cochrane review found that for adults with severe CAP, the number needed to treat with corticosteroids was 18 patients to prevent one death (1).
(Note that studies of neonates, Pneumocystis jiroveci pneumonia, and HIV patients were excluded from meta-analyses evaluating this topic).
References:
(1) Seagraves T, et al. Ann Emerg Med. 2019 Jul;74(1):e1-e3.
(2) Pliakos EE, et al. Chest. 2019 Apr;155(4):787-794.
(3) Stern A, et al. Cochrane Database Syst Rev. 2017 Dec 13;12:CD007720.
EMCY 