Efficacy of Corticosteroids in the Treatment of Community-Acquired Pneumonia Requiring Hospitalization

Mikami, Katsunaka; Suzuki, Mitsuaki; Kitagawa, Hiroshi; Kawakami, Masaki; Hirota, Nobuaki; Yamaguchi, Hiromichi; Narumoto, Osamu; Kichikawa, Yoshiko; Kikuchi, Makoto; Tashimo, Hiroyuki; Arai, Hidenori; Horiuchi, Tadashi; Sakamoto, Yoshio

doi:10.1007/s00408-007-9020-3

Cited by 136 publications

(144 citation statements)

References 28 publications

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“…A retrospective cohort study conducted by Garcia-Vidal et al 28 pointed out that mortality decreased in the patients with severe CAP who received steroids along with antibiotic treatment. Mikami et al 27 demonstrated that a short course of low-dose corticosteroids administered to patients with moderate-to-severe CAP promoted the resolution of clinical symptoms and reduced the duration of intravenous antibiotic therapy. In a retrospective study about the efficacy of MPDN therapy in patients with severe pneumonia, Kiyokawa and Kawai 31 suggested that the administration of steroids in the early stage after the onset of pneumonia could increase the average cure rate.…”

Section: Discussionmentioning

confidence: 99%

“…We excluded 3 trials because they investigated patients with mild-to-severe CAP without classification. [33][34][35] Another trial 27 was excluded because it evaluated patients with a wide spectrum of severity (from classes I to V) but did not present mortality data in a subgroup of patients with severe CAP. At last, we decided to exclude the study by Marik et al 20 from the analysis because its design was different from the other studies in that a single dose of corticosteroids prior to antibiotic therapy was used.…”

Section: Trial Flowmentioning

confidence: 99%

“…In contrast, one meta-analysis 23 investigated the outcome of the administration of corticosteroids, especially prolonged therapy, and found that corticosteroid treatment was associated with reduced mortality in a subgroup of patients with severe CAP. Four RCTs [24][25][26][27] and one cohort study 28 concluded that corticosteroids combined with antibiotic therapy decreased mortality and improved outcomes of in-patients with severe CAP. Therefore, we conducted this meta-analysis to investigate the efficacy of corticosteroids in the management of severe CAP.…”

Section: Introductionmentioning

confidence: 99%

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Corticosteroid Therapy for Severe Community-Acquired Pneumonia: A Meta-Analysis

Cheng¹,

Yang

Gao³

et al. 2013

Respir Care

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BACKGROUND:The debate about the efficacy of corticosteroids in the treatment of severe community-acquired pneumonia (CAP) is still a longstanding dilemma. We performed a meta-analysis including 4 randomized controlled trials (RCTs) to evaluate the effect of corticosteroids on the treatment of severe CAP in adults. METHODS: We performed a systematic review of published and unpublished clinical trials. Databases, including PubMed, Embase, CINAHL, and Cochrane (from their establishment to July 2013), were searched for relevant articles. Only RCTs of corticosteroids as adjunctive therapy in adult patients with severe CAP were selected. RESULTS: Four trials enrolling 264 patients with severe CAP were included. Use of corticosteroids significantly reduced hospital mortality compared with conventional therapy and placebo (Peto odds ratio ‫؍‬ 0.39, 95% CI 0.17-0.90). The quality of the evidence underlying the pooled estimate of effect on hospital mortality was low, downgraded for inconsistency and imprecision. CONCLUSIONS: On the basis of the current limited evidence, we suggest that, although corticosteroid therapy may reduce mortality and improve the prognosis of adult patients with severe CAP, the results should be interpreted with caution due to the instability of pooled estimates. Reliable treatment recommendations will be raised only when large sufficiently powered multi-center RCTs are conducted.

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Section: Discussionmentioning

confidence: 99%

Section: Trial Flowmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Corticosteroid Therapy for Severe Community-Acquired Pneumonia: A Meta-Analysis

Cheng¹,

Yang

Gao³

et al. 2013

Respir Care

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“…in patients with chronic obstructive pulmonary disease ⁄ asthma or virus-induced pneumonia) [29,30]. These potential beneficial effects of corticosteroids have been investigated in several clinical trials in which corticosteroids have been used as adjunctive therapy in patients with sepsis and septic shock as well as in those with pneumonia [28,[31][32][33][34][35][36]. In pneumonia, the findings of studies of corticosteroid therapy have not been conclusive (Table 1).…”

Section: Corticosteroidsmentioning

confidence: 99%

Treatment with anti‐inflammatory drugs in community‐acquired pneumonia

Meijvis

Garde

Rijkers

et al. 2012

Journal of Internal Medicine

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“…As a result, investigators have evaluated the use of immunomodulatory agents in an attempt to control this exaggerated inflammatory response and reduce patient mortality. Corticosteroids are the primary immunomodulatory agents considered for patients with CAP, and results of several investigations [1][2][3][4][5][6][7][8][9][10] have been evaluated in recent system- ‡ Correspondence To: Timothy Wiemken MedCenter One 501 E. Broadway 120B Louisville, Kentucky 40202, USA Phone: 502-852-4627 Email: tim.wiemken@louisville.edu atic reviews and meta-analyses 11,12 Although steroids are considered important immunomodulatory agents for these patients, other considerations include macrolides [13][14][15][16][17][18] statins [19][20][21][22][23][24][25][26][27][28][29] and tissue factor pathway inhibitor 30 .…”

Section: Introductionmentioning

confidence: 99%

Untitled

2017

JRI

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Purpose: Patients with severe community-acquired pneumonia (CAP) are believed to have an exaggerated inflammatory response to bacterial infection. Therapies aiming to modulate the inflammatory response have been largely unsuccessful, perhaps reflecting that CAP is a heterogeneous disorder that cannot be modulated by a single anti-inflammatory approach. We hypothesize that the host inflammatory response to pneumonia may be characterized by distinct cytokine patterns, which can be harnessed for personalized therapies. Methods: Here, we use hierarchical cluster analysis of cytokines to examine if patterns of inflammatory response in 13 hospitalized patients with CAP can be defined. This was a secondary data analysis of the Community-Acquired Pneumonia Inflammatory Study Group (CAPISG) database. The following cytokines were measured in plasma and sputum on the day of admission: interleukin (IL)-1β , IL-1 receptor antagonist (IL-1ra), IL-6, CXCL8 (IL-8), IL-10, IL-12p40, IL-17, interferon (IFN)γ, tumor necrosis factor (TNF)α, and CXCL10 (IP-10). Hierarchical agglomerative clustering algorithms were used to evaluate clusters of patients within plasma and sputum cytokine determinations. Results: A total of thirteen patients were included in this pilot study. Cluster analysis identified distinct inflammatory response patterns of cytokines in the plasma, sputum, and the ratio of plasma to sputum. Conclusions: Inflammatory response patterns in plasma and sputum can be identified in hospitalized patients with CAP. Characterization of the local and systemic inflammatory response may help to better discriminate patients for enrollment into clinical trials of immunomodulatory therapies.

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Efficacy of Corticosteroids in the Treatment of Community-Acquired Pneumonia Requiring Hospitalization

Abstract: In moderate-severe CAP, administration of corticosteroids promotes resolution of clinical symptoms and reduces the duration of intravenous antibiotic therapy.

Cited by 136 publications

References 28 publications

Corticosteroid Therapy for Severe Community-Acquired Pneumonia: A Meta-Analysis

Corticosteroid Therapy for Severe Community-Acquired Pneumonia: A Meta-Analysis

Treatment with anti‐inflammatory drugs in community‐acquired pneumonia

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