Steroids in the Treatment of Community-Acquired Pneumonia

Ann Intern Med 2015 Oct 6; 163:519 and Ann Intern Med 2015 Oct 6; 163:560
Two recent RCTs (Lancet 2015; 385:1511 and JAMA 2015 313:677) showed outcome improvements with steroid therapy in CAP, but not powered to detect mortality differences.
Meta-analysis of 13 RCTs (n > 2000 hospitalized pts)
Moderate systemic steroid doses (prednisone 20-60mg or equivalent daily)
Lowered in-hospital mortality (5.3% vs 7.9%, NNT = 38)
Lowered ARDS (0.4% vs 3.0%, NNT = 38)
Lowered mechanical ventilation (3.1% vs 5.7%, NNT = 38)
Shortened hospital stay by 1 day
Mortality benefit only in group with severe PNA (NNT = 7)
Hyperglycemia more common in steroid group.
Large RCT is underway, due in 2018.
Take away:  consider short (5-7 days) course of moderate-dose (20-60mg) steroid in inpt PNA.
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