Corticosteroids in severe pneumonia: Table 1—

Abstract

The mortality rate in severe community-or hospital-acquired pneumonia is very high, ranging 20-50%. Despite advances in antimicrobial therapy and supportive measures, this rate has not changed in recent years, suggesting that other factors are also responsible for the poor outcome. An abnormal increase in the local and systemic inflammatory response is associated with poor outcome, and this occurs despite adequate antibiotic therapy.There is evidence that acute administration of corticosteroids decreases the inflammatory response and might decrease mortality in severe pneumonia. This has been shown in one small randomised controlled study, terminated prematurely due to 0% mortality in the intervention arm. In addition, an experimental study showed that glucocorticosteroids decrease lung inflammatory response and lung bacterial burden, confirming the results obtained through in vitro investigations.Although these results are promising and suggest a novel role of glucocorticosteroids in pneumonia, the inherent risks and potential side-effects of these drugs require further controlled clinical trials in order to better define the target population before their general use in clinical practice. Specifically, dosage, period of administration, titration, tapering and side-effects are some of the key questions that need to be investigated.

Adjunct Corticosteroids in Children Hospitalized With Community-Acquired Pneumonia

“…5,8 Considerable morbidity may occur in patients with CAP, even in the presence of appropriate antibiotic therapy. [9][10][11] Corticosteroids inhibit the expression of many proinflammatory cytokines released during the course of CAP infection, 7,12 and corticosteroid treatment may be a useful adjunct therapy in patients with CAP. Systemic corticosteroid therapy is associated with better outcomes for children with other infections, including bacterial meningitis caused by Haemophilus influenzae type B, 13 and pneumonia caused by Pneumocystis jiroveci.…”

Impact and indication of early systemic corticosteroids for very severe community-acquired pneumonia

“…Corticosteroids inhibit the expression and action of many cytokines involved in inflammatory responses by binding to their specific receptors, which are located in the cytoplasm of nearly all human cells 16. Therefore, systemic corticosteroids can suppress inflammatory responses in specific tissues as well as in the whole body.…”

Revisiting steroid treatment for septic shock: molecular actions and clinical effects - a review

“…In recent years, the use of corticosteroids has been suggested to be effective in selected patients with community acquired pneumonia (CAP) (Confalonieri et al 2005, Sibila et al 2008. Nevertheless, recent reviews concluded that available studies cannot support recommendation for corticosteroids as standard of care for patients severe CAP (Salluh et al 2008b, Sibila et al 2008.…”

“…In recent years, the use of corticosteroids has been suggested to be effective in selected patients with community acquired pneumonia (CAP) (Confalonieri et al 2005, Sibila et al 2008. Nevertheless, recent reviews concluded that available studies cannot support recommendation for corticosteroids as standard of care for patients severe CAP (Salluh et al 2008b, Sibila et al 2008. In a recent study, we have studied 191 patients with CAP and concluded that in patients with severe CAP, adjunctive therapy with corticosteroids may facilitate the weaning of vasopressors but has no influence on mortality, on the clinical course assessed by the SOFA score or on the C reactive protein course.…”