Adjuvant role of corticosteroids in the treatment of community-acquired pneumonia

Nafae, Ramadan M.; Ragab, Mostafa; Amany, Fawzy M.; Rashed, Shimaa B.

doi:10.1016/j.ejcdt.2013.03.009

Cited by 64 publications

(68 citation statements)

References 14 publications

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“…An Egyptian single blind study of 80 patients found that mortality was significantly reduced in patients taking a similar solumedrol regimen versus placebo (four deaths versus six for placebo; P<0.05). 101 As no other study, including larger studies using the same dosing regimen, has shown even remotely comparable benefits, these results are not considered generalizable.…”

Section: The Role Of Biomarkersmentioning

confidence: 93%

Advances in the causes and management of community acquired pneumonia in adults

Wunderink

Waterer

2017

BMJ

153

103

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Community acquired pneumonia remains a common cause of morbidity and mortality. Usually, the causal organism is not identified and treatment remains empiric. Recent computed tomography and magnetic resonance imaging studies have challenged the accuracy of the clinical diagnosis of pneumonia, and epidemiologic studies are changing our perspective of what causes community acquired pneumonia, especially the role of viral pathogens and the frequent finding of multiple pathogens. The past decade has seen increasing overuse of empiric coverage of meticillin resistant and antibiotic resistant Gram negative pathogens owing to inappropriate application of guidelines for healthcare associated pneumonia. Optimal treatment remains a matter for debate, especially in very sick patients, including the role of combination antibiotic therapy and corticosteroids. Pneumonia care bundles are being defined to improve outcomes. Increased recognition of both acute and long term cardiac complications is shifting our concept of pneumonia from an acute lung disease to a multisystem problem with adverse chronic health consequences.

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Section: The Role Of Biomarkersmentioning

confidence: 93%

Advances in the causes and management of community acquired pneumonia in adults

Wunderink

Waterer

2017

BMJ

153

103

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“…ICU stay; [72][73][74][75][76]78,79,82 and length of hospital stay [71][72][73][74][75][76]78,79,81,82,84 (Table 7, Figure 5). Meta-analysis of 8 RCTs 71,72,75,78,79,81,82,84 showed that corticosteroids may increase the rate of serious hyperglycemia (RD 5.7%, 95% CI 0.18% to 15.3%; moderate-quality evidence for CAP, low quality after rating down 1 level for indirectness).…”

Section: Researchmentioning

confidence: 99%

Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis

Wang

Colunga‐Lozano

et al. 2020

CMAJ

194

160

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“…Based on the inclusion and exclusion criteria, 1672 studies were excluded. Finally, 8 RCTs were included for meta-analysis [17–19, 21, 22, 24, 26, 28], and a PRISMA flow diagram of selection process for studies was shown in Fig 1. Among included RCTs, one study included mild to severe CAP patients, we selected the severe CAP cases which were defined by PSI of IV or V[21].…”

Section: Resultsmentioning

confidence: 99%

“…We included all eligible trials with high quality and a low risk of bias except one study [26]. Usually, clinicians used adjunctive corticosteroids therapy for severe CAP especially in the early stage.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Adjunctive Corticosteroids Therapy for Severe Community-Acquired Pneumonia in Adults: An Updated Systematic Review and Meta-Analysis

Yang

Wang

et al. 2016

PLoS ONE

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BackgroundAdjunctive corticosteroids therapy is an attractive option for community-acquired pneumonia (CAP) treatment. However, the effectiveness of adjunctive corticosteroids on mortality of CAP remains inconsistent, especially in severe CAP. We performed a meta-analysis to evaluate the efficacy and safety of adjunctive corticosteroids in severe CAP patients.MethodsThree databases of PubMed, EMBASE and Cochrane Library were searched for related studies published in English up to December, 2015. Randomized controlled trials (RCTs) of corticosteroids in hospitalized adults with severe CAP were included. Meta-analysis was performed by a random-effect model with STATA 11.0 software. We estimated the summary risk ratios (RRs) or effect size (ES) with its corresponding 95% confidence interval (95%CI) to assess the outcomes.ResultsWe included 8 RCTs enrolling 528 severe CAP patients. Adjunctive corticosteroids significantly reduced all-cause mortality (RR = 0.46, 95%CI: 0.28 to 0.77, p = 0.003), risk of adult respiratory distress syndrome (ARDS) (RR = 0.23, 95%CI: 0.07 to 0.80, p = 0.02) and need for mechanical ventilation (RR = 0.50, 95%CI: 0.27 to 0.92, p = 0.026). Adjunctive corticosteroids did not increase frequency of hyperglycemia requiring treatment (RR = 1.03, 95%CI: 0.61 to 1.72, p = 0.91) or gastrointestinal hemorrhage (RR = 0.66, 95%CI: 0.19 to 2.31, p = 0.52). In subgroup analysis by duration of corticosteroids, we found that prolonged corticosteroids therapy significantly reduced all-cause mortality (RR = 0.41, 95%CI: 0.20 to 0.83, p = 0.01) and length of hospital stay (−4.76 days, 95% CI:-8.13 to -1.40, p = 0.006).ConclusionsResults from this meta-analysis suggested that adjunctive corticosteroids therapy was safe and beneficial for severe CAP. In addition, prolonged corticosteroids therapy was more effective. These results should be confirmed by adequately powered studies in the future.

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Adjuvant role of corticosteroids in the treatment of community-acquired pneumonia

Cited by 64 publications

References 14 publications

Advances in the causes and management of community acquired pneumonia in adults

Advances in the causes and management of community acquired pneumonia in adults

Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis

Efficacy and Safety of Adjunctive Corticosteroids Therapy for Severe Community-Acquired Pneumonia in Adults: An Updated Systematic Review and Meta-Analysis

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