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Outcome of early short course corticosteroid therapy in severe community-acquired pneumonia: a randomised controlled
Abhishek Singh1, Niranjan Biswal2, C G DelhiKumar1
1Pediatrics, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India.
Insights
Adjunctive dexamethasone significantly reduced treatment failure in children with severe community-acquired pneumonia (CAP). This steroid therapy improved outcomes without increasing adverse events, supporting its use in pediatric CAP management.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Respiratory Medicine
Background:
- Severe community-acquired pneumonia (CAP) in children poses significant clinical challenges.
- Current treatment guidelines for pediatric CAP may benefit from adjunctive therapies.
- Evaluating novel treatment strategies is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the efficacy and safety of dexamethasone as an add-on treatment for severe CAP in pediatric patients.
- To determine the impact of adjunctive dexamethasone on key clinical outcomes and inflammatory markers.
- To provide evidence-based recommendations for the management of severe pediatric CAP.
Main Methods:
- A double-blind, randomized, placebo-controlled trial was conducted in a tertiary care hospital.
- Children aged 2 months to 15 years with severe CAP received either intravenous dexamethasone or placebo for 5 days, alongside standard antimicrobial therapy.
- Primary outcome was treatment failure at 72 hours; secondary outcomes included radiographic progression, respiratory failure, and mortality.
Main Results:
- Adjunctive dexamethasone significantly reduced treatment failure at 72 hours compared to placebo (25.8% vs 60.6%).
- Dexamethasone group showed significantly lower rates of radiographic worsening and progression to respiratory failure.
- No significant differences were found in the need for ventilation, shock, mortality, hospital stay, or readmission rates.
Conclusions:
- Dexamethasone as adjunctive therapy demonstrated significant efficacy in reducing early treatment failure in severe pediatric CAP.
- The treatment was associated with reduced systemic inflammation and did not increase adverse outcomes.
- These findings support the consideration of dexamethasone in the management of severe CAP in children.
Objective:
To evaluate the efficacy and safety of adjunctive dexamethasone in children with severe community-acquired pneumonia (CAP).
Design:
Double-blind, randomised, placebo-controlled trial.
Setting:
Tertiary care hospital.
Patients:
Children aged 2 months to 15 years diagnosed with severe CAP.
Intervention:
Participants were randomised to receive intravenous dexamethasone or placebo for 5 days, in addition to standard antimicrobial therapy.
Main Outcome Measures:
The primary outcome was treatment failure at 72 hours. Secondary outcomes included radiographic progression, respiratory failure, need for ventilation, shock, mortality, length of hospital stay, 4-week readmission and inflammatory markers.
Results:
132 children were enrolled (66 per group). Treatment failure at 72 hours occurred in 25.8% in the dexamethasone group vs 60.6% in the placebo group (HR 0.32; 95% CI 0.18 to 0.57; p=0.001). Radiographic worsening was significantly lower in the dexamethasone group (22.7% vs 57.6%; OR 0.22; p=0.001), as was progression to respiratory failure (10.6% vs 31.8%; OR 0.25; p=0.004). No significant differences were observed in need for ventilation, development of shock, mortality, hospital stay or readmission rates. While the reduction in erythrocyte sedimentation rate (ESR) from baseline to 72 hours was greater in the dexamethasone group, absolute ESR values at 72 hours did not differ consistently between groups, whereas no significant differences were observed in high-sensitivity C reactive protein, interleukin (IL)-6, IL-8 or IL-10.
Conclusions:
Dexamethasone as adjunctive therapy in severe paediatric CAP significantly reduced early treatment failure and systemic inflammation without increasing adverse outcomes. These findings support its consideration in the management of severe CAP in children.
Trial Registration Number:
CTRI/2021/09/036799.
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