Written by Rebecca DiFabio
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This double-blind, randomized controlled trial found significantly lower rates of treatment failure in severe pediatric CAP when adding dexamethasone to antibiotics and supportive care, and no increase in adverse effects.
Short course, big effect
Worldwide, pneumonia continues to be a leading cause of pediatric mortality, with in-hospital mortality of 10–12% in high-income countries. Adjunctive corticosteroids in adult community-acquired pneumonia (CAP) are well studied, though their role in pediatrics is less understood.
This double-blind, randomized controlled trial in a tertiary health centre in South India studied the impact of 3 days of adjunctive dexamethasone in children admitted with severe CAP. Of the children who received dexamethasone, treatment failure at 72 hours was observed in only 17 of 66 (25.8%; 95%CI 15.3–36.3) versus 40 of 66 in the placebo group (60.6%; 95%CI 48.5–72.1). This included progression to respiratory failure in 7/66 with dexamethasone compared to 28/66 in the placebo group (OR 0.25; 95%CI 0.10–0.65, p=0.004). There was no difference in mortality rates, hospitalization duration, 28-day readmission, or adverse effects. The number needed to treat to prevent one treatment failure was 4 (95%CI 2.5-11.5).
This study was small and underpowered to detect differences in rates of mechanical ventilation or development/progression of shock, so it would be great to see a large, multi-center study, because these numbers are pretty impressive.
How does this change my practice?
Though this was a small study, the results are promising. While I don’t see critically ill pediatrics very often, I’ll absolutely be keeping dexamethasone in my repertoire, and it is a great point of discussion with the admitting pediatric intensivists.
Editor’s Note: Treatment failure was a composite outcome. The difference was driven by respiratory failure and radiographic progression. Also, I’m not sure what 1/ARR numbers they used, but 1/(0.606–0.258) = NNT of 3, not 4. ~Clay Smith
Source
Outcome of early short course corticosteroid therapy in severe community-acquired pneumonia: a randomised controlled trial. Arch Dis Child. 2026 Apr 15:archdischild-2025-328990. doi: 10.1136/archdischild-2025-328990. Epub ahead of print. PMID: 41663239.
