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Corticosteroids for Community-Acquired Pneumonia

 


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Am Fam Physician. 2016 Jun 1;93(11):online.

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CORTICOSTEROIDS FOR COMMUNITY-ACQUIRED PNEUMONIA

Number needed to treat = 20 to avoid mechanical ventilation; 16 to avoid ARDS Number needed to harm = 29 for developing hyperglycemia
BenefitsHarms

1 in 20 avoided mechanical ventilation

1 in 29 developed hyperglycemia requiring treatment

1 in 16 avoided ARDS

No deaths were prevented


ARDS = acute respiratory distress syndrome.

CORTICOSTEROIDS FOR COMMUNITY-ACQUIRED PNEUMONIA

Number needed to treat = 20 to avoid mechanical ventilation; 16 to avoid ARDS Number needed to harm = 29 for developing hyperglycemia
BenefitsHarms

1 in 20 avoided mechanical ventilation

1 in 29 developed hyperglycemia requiring treatment

1 in 16 avoided ARDS

No deaths were prevented


ARDS = acute respiratory distress syndrome.

Details for This Review

Study Population: Adults with community-acquired pneumonia (CAP)1

Efficacy End Points: All-cause mortality; need for mechanical ventilation; rate of acute respiratory distress syndrome (ARDS); length of hospital stay

Harm

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. Siemieniuk RA, Meade MO, Alonso-Coello P, et al. Corticosteroid therapy for patients hospitalized with community-acquired pneumonia: a systematic review and meta-analysis. Ann Intern Med. 2015;163(7):519–528....

2. Mizgerd JP. Acute lower respiratory tract infection. N Engl J Med. 2008;358(7):716–727.

3. Xu J, Murphy SL, Kochanek KD, Bastian BA. Deaths: final data for 2013. Natl Vital Stat Rep. 2016;64(2):1–119.

4. Thomas CP, Ryan M, Chapman JD, et al. Incidence and cost of pneumonia in Medicare beneficiaries. Chest. 2012;142(4):973–981.

5. Rittirsch D, Flierl MA, Ward PA. Harmful molecular mechanisms in sepsis. Nat Rev Immunol. 2008;8(10):776–787.

6. Remmelts HH, Meijvis SC, Biesma DH, et al. Dexamethasone downregulates the systemic cytokine response in patients with community-acquired pneumonia. Clin Vaccine Immunol. 2012;19(9):1532–1538.

7. Torres A, Sibila O, Ferrer M, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA. 2015;313(7):677–686.

8. Blum CA, Nigro N, Briel M, et al. Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial. Lancet. 2015;385(9977):1511–1518.



 

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