Corticosteroids for pneumonia

Abstract

BackgroundPneumonia is a common and potentially serious illness. Corticosteroids have been suggested for the treatment of different types of infection, however their role in the treatment of pneumonia remains unclear. This is an update of a review published in 2011. ObjectivesTo assess the efficacy and safety of corticosteroids in the treatment of pneumonia. Search methodsWe searched the Cochrane Acute Respiratory Infections Group's Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS on 3 March 2017, together with relevant conference proceedings and references of identified trials. We also searched three trials registers for ongoing and unpublished trials. Selection criteriaWe included randomised controlled trials (RCTs) that assessed systemic corticosteroid therapy, given as adjunct to antibiotic treatment, versus placebo or no corticosteroids for adults and children with pneumonia. Data collection and analysisWe used standard methodological procedures expected by Cochrane. Two review authors independently assessed risk of bias and extracted data. We contacted study authors for additional information. We estimated risk ratios (RR) with 95% confidence intervals (CI) and pooled data using the Mantel-Haenszel fixed-effect model when possible. Main resultsWe included 17 RCTs comprising a total of 2264 participants; 13 RCTs included 1954 adult participants, and four RCTs included 310 children. This update included 12 new studies, excluded one previously included study, and excluded five new trials. One trial awaits classification.All trials limited inclusion to inpatients with community-acquired pneumonia (CAP), with or without healthcare-associated pneumonia (HCAP). We assessed the risk of selection bias and attrition bias as low or unclear overall. We assessed performance bias risk as low for nine trials, unclear for one trial, and high for seven trials. We assessed reporting bias risk as low for three trials and high for the remaining 14 trials.

Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis

“…For ARDS, our review showed similar results to the 1 other published systematic review 29 that included the latest published studies. For CAP, the results on which we focus are similar to those of other recent reviews [86][87][88][89] that showed that corticosteroids may reduce mortality and length of hospital stay, and increase hyperglycemia.…”

Cardiovascular Events after Community-Acquired Pneumonia: A Global Perspective with Systematic Review and Meta-Analysis of Observational Studies

“…Corticosteroids have been tested in a wide spectrum of infectious diseases, yielding controversial results. In CAP, one large patient level meta-analysis [81] pointed to a mortality benefit (34% relative risk reduction), while in another meta-analysis [82] a very similar absolute reduction reached statistical significance with one of two random-effects models. In both studies, shorter length of stay (~1 day) and more hyperglycemic episodes were noted.…”

Community-acquired pneumonia as an emergency condition

“…A 2017 update [55] of a previously published review assessed the efficacy and safety of systemic corticosteroids, given as adjunct to antibiotic therapy, compared to placebo or no corticosteroids in the treatment of pneumonia. Corticosteroids reduced mortality and morbidity in adults with severe CAP; the number needed to treat for an additional beneficial outcome was 18 patients (95% CI 12-49) to prevent one death.…”