Corticosteroids in the treatment of community-acquired pneumonia: an evidence summary

A strong inflammatory response to community-acquired pneumonia (CAP) is associated with excess morbidity and mortality. There is a growing interest in corticosteroids as an adjunctive treatment for patients hospitalized with CAP. We review recent randomized trials addressing the use of corticosteroids across the full range of CAP patients. Thirteen randomized controlled trials including 2005 patients have addressed the effect of short-term (single dose to 10 days) corticosteroid administration in patients with CAP. The results consistently show a shorter time to clinical stability and a shorter length of hospital stay on the order of 1 day. Some studies have also suggested a possible reduction in mortality. Adverse effects, primarily hyperglycemia and neuropsychiatric symptoms, are uncommon and neither serious nor prolonged. The results indicate a possibility that steroid administration should become a standard of care for patients with CAP.