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Systemic Corticosteroids in Children With Pneumonia: Α Systematic Review and Meta-analysis
Maria Geropeppa1, Panagiota Tsagkli1, Ioanna Papadatou1,2
1From the Immunobiology and Vaccinology Research Laboratory, Infectious Diseases Department "MAKKA," First Department of Paediatrics, "Aghia Sophia" Children's Hospital, Athens Medical School, Athens, Greece.
Insights
Adjunct corticosteroid therapy may shorten hospital stays and reduce fever duration in pediatric community-acquired pneumonia (CAP). While safe and manageable, further research is needed to optimize corticosteroid use in treating CAP in children.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Respiratory Medicine
Background:
- Corticosteroids are established treatments for specific infectious diseases.
- The efficacy and safety of corticosteroids in pediatric community-acquired pneumonia (CAP) are not well-defined.
- This study evaluates adjunct corticosteroid therapy in pediatric CAP.
Purpose of the Study:
- To assess the efficacy of systemic corticosteroids as an adjunct treatment for pediatric CAP.
- To evaluate the safety profile of corticosteroid use in children with CAP.
- To determine the impact of corticosteroids on clinical outcomes like hospital stay and fever duration.
Main Methods:
- A systematic literature search was performed on MEDLINE up to December 31, 2024.
- Included studies assessed systemic corticosteroids alongside antimicrobial regimens in pediatric CAP.
- Meta-analysis was conducted on data from randomized clinical trials and observational studies, assessing heterogeneity and publication bias.
Main Results:
- The systematic review included 22 articles (N=75,353).
- Meta-analysis of 7 studies showed significantly reduced length of hospital stay (LOS) and time to defervescence in pediatric CAP patients receiving corticosteroids in randomized trials (P=0.001 and P<0.001, respectively).
- Corticosteroids were associated with faster radiologic and clinical recovery, particularly in Mycoplasma pneumoniae and viral pneumonia with wheezing; adverse events were infrequent and manageable.
Conclusions:
- Adjunct corticosteroid therapy shows potential benefits for selected pediatric CAP patients.
- Further research is required to establish optimal protocols for corticosteroid administration in pediatric CAP.
- The findings suggest a possible advantage in specific pediatric CAP cases, warranting further investigation into timing and dosage.
Background:
Corticosteroids are effective adjunct treatment for certain infectious diseases. However, their role in children with community-acquired pneumonia (CAP) remains unclear. We aim to assess the efficacy and safety of adjunct corticosteroid therapy in pediatric CAP.
Materials And Methods:
A systematic literature search was conducted on MEDLINE to retrieve studies assessing systemic corticosteroid therapy, given alongside antimicrobial regimens, in pediatric CAP (last search date December 31, 2024). Literature screening, quality assessment, and data extraction were conducted by 2 independent reviewers. Heterogeneity and publication bias were detected by I2 and Egger's tests. The data were pooled using the random-effects model for the conduction of meta-analysis.
Results:
Twenty-two articles (N = 75.353) of 3799 screened studies were included in the systematic review; 7 of 22 studies providing data on length of hospital stay (LOS) and duration of fever for corticosteroid-treated versus control patients were included in the meta-analysis. Significant heterogeneity was observed regarding the regimen, dosage and duration of corticosteroid therapy. Regarding meta-analysis, LOS and time to defervescence were significantly decreased in patients receiving corticosteroids compared to controls in randomized clinical trials (Cohen's d value = -0.59, 95% confidence interval: -0.96 to -0.23, P = 0.001 , I2 = 52.6%; Cohen's d value =-0.54, 95% confidence interval: -0.83 to -0.26, P < 0.001 , I2 = 26.1%, respectively), but not in observational studies. Corticosteroid administration was associated with a shorter radiologic and clinical recovery time especially for Mycoplasma pneumoniae and viral pneumonia with wheezing. Corticosteroid-related adverse events were infrequent and manageable.
Conclusions:
Our analysis suggests a possible advantage for corticosteroid therapy in selected pediatric patients with CAP. Further studies are needed to clarify how, when, and where corticosteroids should be added to the treatment plan of pediatric CAP.
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