community acquired pneumonia (CAP) and steroids (steroid use in CAP)

Last edited 05/2023 and last reviewed 05/2023

There is evidence regarding positive outcomes from using oral steroid treatment in community acquired pneumonia (CAP):

  • a systematic review regarding the use of steroids in hospitalized patients with CAP was undertaken (1)
    • this concluded:
      • for hospitalized adults with CAP, systemic corticosteroid therapy may reduce mortality by approximately 3%, need for mechanical ventilation by approximately 5%, and hospital stay by approximately 1 day

  • a further systematic review concluded (2):
    • corticosteroid therapy reduced mortality and morbidity in adults with severe CAP; the number needed to treat for an additional beneficial outcome was 18 patients (95% CI 12 to 49) to prevent one death
    • corticosteroid therapy reduced morbidity, but not mortality, for adults and children with non-severe CAP
    • corticosteroid therapy was associated with more adverse events, especially hyperglycaemia, but the harms did not seem to outweigh the benefits

  • considering both adult and paediatric patients (3)
    • a systematic review stated that the "take home message" was that
      • "..for adult patients with severe community-acquired pneumonia, corticosteroids reduce morbidity and mortality. For pediatric patients and adults with nonsevere community-acquired pneumonia, corticosteroids appear to reduce morbidity, but not mortality"
      • the authors stated that
        • current data suggest that corticosteroids reduce morbidity and mortality in severe community-acquired pneumonia
          • corticosteroids were also shown to be beneficial in patients with nonsevere community-acquired pneumonia who were admitted to the hospital
          • administration of corticosteroids was associated with an increased rate of hyperglycemia, without a difference in other adverse events
        • limitations of the review were highlighted:
          • studies included in the meta-analysis varied in the doses, days of total treatment, and type of corticosteroid administered
          • review included patients with a variety of medical conditions (eg, chronic obstructive pulmonary disease, diabetes), who may respond differently than patients without these comorbidities
          • many of the outcomes were limited by small sample sizes, with one study comprising nearly half of all of the included patients
          • sample sizes in the pediatric studies were very small

  • a systematic review found (4):
    • corticosteroid therapy is associated with a lower incidence of progression to requiring mechanical ventilation among patients hospitalized with CAP
    • no association was found between corticosteroid therapy and mortality, treatment failure, or adverse events

  • steroid therapy in adults who had been admitted to the intensive care unit (ICU) for severe CAP
    • among patients with severe community-acquired pneumonia being treated in the ICU, those who received hydrocortisone had a lower risk of death by day 28 than those who received placebo (5)

  • a review (18 RCTs; n=4,661) found corticosteroids probably reduce mortality in more severe community-acquired pneumonia (RR 0.62 [95% CI 0.45 to 0.85]; moderate certainty) and probably reduce risk of requiring invasive mechanical ventilation and ICU admission (6)

Reference:

Related pages:

community acquired pneumonia (CAP)