A Controlled Blind Study of Pneumococcal Pneumonia Treated With Tetracycline and Tetracycline Plus 6-Methyl Prednisolone

Kirby, James C.; G, Polis; Romansky, Monroe J.

doi:10.1097/00000441-196007000-00004

Cited by 6 publications

(3 citation statements)

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“…A total of 772 studies were retrieved, and the process of identifying relevant trials is shown in Figure 1 . Among the 772 initially potentially relevant studies, one study was searched from Google Scholar through reviewing the cited lists of eligible trials [14] , and three studies were identified from reviews by hand searched [19] – [21] . 748 studies were excluded because of irrelevant, review or commentary articles.…”

Section: Methodsmentioning

confidence: 99%

Corticosteroids in the Treatment of Community-Acquired Pneumonia in Adults: A Meta-Analysis

Nie

Zhang²,

Cheng

et al. 2012

PLoS ONE

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BackgroundThe benefit of corticosteroids in community-acquired pneumonia (CAP) remains controversial. We did a meta-analysis to include all the randomized controlled trials (RCTs) which used corticosteroids as adjunctive therapy, to examine the benefits and risks of corticosteroids in the treatment of CAP in adults.MethodsDatabases including Pubmed, EMBASE, the Cochrane controlled trials register, and Google Scholar were searched to find relevant trials. Randomized and quasi-randomized trials of corticosteroids treatment in adult patients with CAP were included. Effects on primary outcome (mortality) and secondary outcomes (adverse events) were accessed in this meta-analysis.ResultsNine trials involving 1001 patients were included. Use of corticosteroids did not significantly reduce mortality (Peto odds ratio [OR] 0.62, 95% confidence interval [CI] 0.37–1.04; P = 0.07). In the subgroup analysis by the severity, a survival benefit was found among severe CAP patients (Peto OR 0.26, 95% CI 0.11–0.64; P = 0.003). In subgroup analysis by duration of corticosteroids treatment, significant reduced mortality was found among patients with prolonged corticosteroids treatment (Peto OR 0.51, 95% CI 0.26–0.97; P = 0.04; I 2 = 37%). Corticosteroids increased the risk of hyperglycemia (Peto OR 2.64, 95% CI 1.68–4.15; P<0.0001), but without increasing the risk of gastroduodenal bleeding (Peto OR 1.67, 95% CI 0.41–6.80; P = 0.47) and superinfection (Peto OR 1.36, 95% CI 0.65–2.84; P = 0.41).ConclusionResults from this meta-analysis did not suggest a benefit for corticosteroids treatment in patients with CAP. However, the use of corticosteroids was associated with improved mortality in severe CAP. In addition, prolonged corticosteroids therapy suggested a beneficial effect on mortality. These results should be confirmed by future adequately powered randomized trials.

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Section: Methodsmentioning

confidence: 99%

Corticosteroids in the Treatment of Community-Acquired Pneumonia in Adults: A Meta-Analysis

Nie

Zhang²,

Cheng

et al. 2012

PLoS ONE

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“…This is based on a few anecdotal cases reported following the Philadelphia outbreak in 1976, largely involving immunocompromised patients 487 . [III] However, there is no evidence to support the statement that patients with community acquired legionella pneumonia require longer therapy than other patients with CAP, and the duration of therapy should be guided as usual by clinical judgement.…”

Section: Section 8 Antibiotic Managementmentioning

confidence: 99%

BTS guidelines for the management of community acquired pneumonia in adults: update 2009

Lim

Baudouin²,

George³

et al. 2009

Thorax

1,181

1,073

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“…In 2 trials of hospitalized patients with pneumococcal pneumonia conducted in the 1950s, 80,81 corticosteroid therapy accelerated defervescence in both and more rapidly relieved anorexia and pleuritic pain in one, 80 but neither showed more rapid radiographic resolution. Fatalities in both studies (1 of 42 patients and 2 of 113 patients) were too infrequent to detect any mortality difference.…”

Section: Bacterial Pneumoniamentioning

confidence: 99%

Use of Corticosteroids in Treating Infectious Diseases

McGee¹

2008

Arch Intern Med

109

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linicians have generally avoided prescribing corticosteroids for active infection because of their known immunosuppressive effects and concern about long-term complications. We conducted a review of the published randomized, double-blind trials comparing corticosteroids and placebo in infections. Except in some trials of viral infections, sore throat, and cerebral cysticercosis, all patients also received active antimicrobial agents in addition to placebo or corticosteroids. For patients with bacterial meningitis, tuberculous meningitis, tuberculous pericarditis, severe typhoid fever, tetanus, or pneumocystis pneumonia with moderate to severe hypoxemia, treatment with corticosteroids improved patient survival (group 1 infections). For patients with bacterial arthritis, corticosteroids were also beneficial and reduced long-term disability (group 2 infections). For about a dozen other infections, corticosteroids significantly relieved symptoms (group 3 infections), and clinicians should consider using them if symptoms are substantial. Corticosteroids were harmful in 2 infections, viral hepatitis and cerebral malaria (group 5 infections). We conclude that corticosteroids are beneficial and safe for a wide variety of infections, although courses longer than 3 weeks should be withheld from patients with concomitant human immunodeficiency virus infection and low CD4 counts.

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A Controlled Blind Study of Pneumococcal Pneumonia Treated With Tetracycline and Tetracycline Plus 6-Methyl Prednisolone

Cited by 6 publications

References 0 publications

Corticosteroids in the Treatment of Community-Acquired Pneumonia in Adults: A Meta-Analysis

Corticosteroids in the Treatment of Community-Acquired Pneumonia in Adults: A Meta-Analysis

BTS guidelines for the management of community acquired pneumonia in adults: update 2009

Use of Corticosteroids in Treating Infectious Diseases

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