Systemic Corticosteroids in Children With Pneumonia: Α Systematic Review and Meta-analysis

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.

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.

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.

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.