The addition of steroids improves outcomes in children and adults with CAP

Reference

Seagraves T, Gottlieb M. Are corticosteroids beneficial in the treatment of community-acquired pneumonia? Ann Emerg Med 2019;74(1):e1-e3.

Synopsis

To conduct this systematic review and meta-analysis, the authors searched 4 databases without language restriction, including Cochrane CENTRAL,and identified 17 randomized controlled trials with a total of 2264 cases of radiographically confirmed pneumonia in children and adults treated with corticosteroid versus placebo or no treatment in addition to usual care. Two investigators independently selected the trials for inclusion and abstracted the data. The corticosteroid varied in type, dose, and route, with the average dose in adults being 40 mg to 50 mg prednisone equivalents daily for an average of 7 days. Corticosteroids decreased mortality in adults with severe CAP (relative risk [RR] 0.58; 95% CI .4 - .84), but not nonsevere CAP. However, treatment resulted in a reduced time to clinical cure, fewer clinical failures, shorter overall hospital stays, fewer ICU stays, and reduced rates of pneumonia complications. In children, corticosteroid treatment reduced the likelihood of clinical failure and decreased the time to clinical cure. Children's mortality, studied in only 2 trials, was not different. Hyperglycemia occurred more often with corticosteroid treatment. The researchers did not evaluate the risk of publication bias. Study results were homogeneous across studies for most outcomes.