Corticosteroids for pneumonia

Pneumonia is an acute respiratory disease that is usually caused by bacteria but it can also be caused by other infectious agents such as fungi, parasites and viruses. Corticosteroids can act as an anti-inflammatory agent for patients with pneumonia but they can adversely suppress the immune system, which prevents the body from fighting the causative pathogens and results in a serious infection. The purpose of this review was to assess whether corticosteroids for pneumonia are beneficial.

We identified six trials (437 participants) and found that although the effects of corticosteroids vary depending on the type and severity of pneumonia, the overall effect is beneficial for most patients. Corticosteroids did not significantly reduce mortality compared to the placebo group. Arrhythmia, upper gastrointestinal bleeding and malignant hypertension may be related to corticosteroids. The evidence from this review is weak due to limitations of the included studies. Large trials with more patients are needed to provide robust evidence.

Authors' conclusions: 

In most patients with pneumonia, corticosteroids are generally beneficial for accelerating the time to resolution of symptoms. However, evidence from the included studies was not strong enough to make any recommendations.

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Background: 

Pneumonia is an acute inflammation of the lungs and treatments differ depending on the type and severity. Corticosteroids can influence immune regulation, carbohydrate metabolism, protein catabolism, electrolyte balance and stress response. However, the benefits of corticosteroids for patients with pneumonia remains unclear.

Objectives: 

To assess the efficacy and safety of corticosteroids in the treatment of pneumonia.

Search strategy: 

We searched Cochrane Central Register of Controlled Clinical Trials (CENTRAL) (The Cochrane Library 2010, Issue 11) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to December week 4, 2010), EMBASE (1974 to December 2010), the China National Knowledge Infrastructure (CNKI) (1978 to December 2010) and VIP (1986 to December 2010).

Selection criteria: 

Randomised controlled trials (RCTs) assessing the effectiveness of corticosteroids for pneumonia.

Data collection and analysis: 

Three review authors selected studies. We telephoned the trial authors to confirm the randomisation method used. We extracted and analysed the methodological details and data from the included studies.

Main results: 

We included six studies including 437 participants in the review. Two studies were of high methodological quality and three were of poor quality. All studies involved small numbers of participants. Two small studies provided weak evidence that corticosteroids did not significantly reduce mortality (Peto odds ratio (OR) 0.26; 95% CI 0.05 to 1.37), but accelerated the resolution of symptoms or time to clinical stability, and decreased the rate of relapse of the disease. Steroids can improve the oxygenation and reduce the need for mechanical ventilation in severe pneumonia. There was no significant difference between treatment groups with regards to the time to discharge from the intensive care unit (ICU). There were insufficient data to report the time to pneumonia resolution and admission to ICU. Typical adverse events associated with corticosteroid therapy were infrequent.

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