Corticosteroids in severe pediatric community-acquired pneumonia:insights from a case-based narrative review

Pediatric community-acquired pneumonia (CAP) remains a leading cause of hospitalization worldwide. Although antimicrobial therapy is the cornerstone of treatment, severe and complicated cases are frequently characterized by an exaggerated inflammatory response that may not resolve with antibiotics alone. In this narrative review, we summarize current evidence on the use of systemic corticosteroids as adjunctive therapy in pediatric CAP and illustrate their potential role through a representative clinical case. Available data from randomized trials, observational studies, and meta-analyses suggest that corticosteroids may shorten fever duration, improve oxygenation, and reduce length of hospital stay in selected pediatric patients, particularly those with hyperinflammatory features, parapneumonic effusions, or macrolide-refractory Mycoplasma pneumoniae infections. Some studies also indicate a reduced need for surgical intervention in complicated pneumonia. However, results remain heterogeneous, and current guidelines do not support routine corticosteroid use. Adverse effects are generally mild with short treatment courses and include hyperglycemia and transient behavioral changes. In the presented clinical case, adjunctive corticosteroid therapy was associated with rapid clinical and radiological improvement in a child with severe hyperinflammatory pleuropneumonia. Corticosteroids may represent a potential adjunctive option in carefully selected children with severe or complicated CAP; however, current evidence remains limited and heterogeneous, and further prospective pediatric studies are required.