Corticosteroids recommended for severe pneumonia

Because the use of corticosteroids in patients with severe community-acquired pneumonia is controversial, researchers in Spain set out to determine the benefits versus the pitfalls of using the adjunctive therapy.

In a new study, published in the February 17, 2015, issue of JAMA, researchers discovered that, if the study findings were replicated, they would support the use of corticosteroids as adjunctive treatment. “Among patients with severe community-acquired pneumonia and high initial inflammatory response, the acute use of methylprednisolone compared with placebo decreased treatment failure,” wrote lead author Antoni Torres, MD, PhD, with the Institut Clínic del Torax, Hospital Clínic in Barcelona, Spain.

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The multicenter, randomized, double-blind, placebo-controlled trial was conducted in 3 Spanish teaching hospitals with patients who had both severe community-acquired pneumonia and a high inflammatory response. Patients were recruited and followed up with from June, 2004, through February, 2012.

Patients were randomly assigned to receive either an intravenous bolus of 0.5 mg/kg per 12 hours of methylprednisolone or placebo for 5 days. The treatment was started within 36 hours of hospital admission.

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The researchers found that there was less treatment failure among patients from the methylprednisolone group (13%), compared with the placebo group (31%). Corticosteroid treatment reduced the risk of treatment failure.

However, in-hospital mortality did not differ much between the two groups: it was 10% in the methylprednisolone group versus 15% in the placebo group.

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