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Should We Use Steroids in Community Acquired Pneumonia Patients?

October 6, 2022

Written by Clay Smith

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Corticosteroid use was associated with a prevention of progression to mechanical ventilation among inpatients with community acquired pneumonia (CAP), but it had no association with the primary outcome of mortality.

Why does this matter?
IDSA CAP guidelines do not recommend corticosteroids in non-severe, severe, or influenza-associated CAP. But RCTs have been back and forth. If we lump RCTs together, what’s the consensus?

Probably not…
This was a meta-analysis of 16 RCTs, with 3,842 hospitalized patients with CAP. There was no difference in the primary outcome of all-cause, in-hospital mortality, RR 0.85 (95%CI 0.67-1.07). There was a significant association with steroids and a reduction in progression to mechanical ventilation RR 0.51 (95%CI 0.33-0.77). On the other hand, use of steroids was associated with subsequent readmission, RR 1.20 (95%CI 1.05-1.38).

Based on this, I don’t feel too enthused with using corticosteroids for CAP inpatients. I think I will stick with the 2019 IDSA guidelines.

Effect of corticosteroids on mortality and clinical cure in community-acquired pneumonia: A systematic review, meta-analysis, and meta-regression of randomized control trials. Chest. 2022 Sep 7;S0012-3692(22)03705-9. doi: 10.1016/j.chest.2022.08.2229. Online ahead of print.

What are your thoughts?