Corticosteroid therapy reduced mortality in adults with severe community-acquired pneumonia (CAP), but not in adults and children with non-severe CAP, according to a recent Cochrane review. 17 randomized clinical trials (RTCs) with 2,264 participants were included in the review; 13 RCTs included 1,954 adult participants and 4 RTCs included 310 children. The RTCs assessed systemic corticosteroid therapy, given as adjunct to antibiotic treatment, vs placebo or no corticosteroids for adults and children with pneumonia. Among the findings:
- Corticosteroids significantly reduced mortality in adults with severe pneumonia (RR, 0.58), but not in adults with non-severe pneumonia (RR, 0.95).
- Corticosteroid therapy reduced morbidity, but not mortality, for adults and children with non-severe CAP.
- Patients treated with corticosteroids had lower clinical failure rates, shorter time to cure, shorter hospital length of stay, and fewer complications.
- Corticosteroid therapy was associated with more adverse events, especially hyperglycemia, but the harms did not outweigh the benefits.
Stern A, Skalsky K, Avni T, Carrara E, Leibovici L, Paul M. Corticosteroids for pneumonia. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD007720. doi:10.1002/14651858.CD007720.pub3.
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