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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 End Points: Hyperglycemia requiring treatment; gastrointestinal bleeding

Narrative: Pneumonia is common, is associated with significant morbidity, and is a leading cause of death.24 In response to infection, the body generates an adaptive inflammatory response.5 Systemic corticosteroids may blunt the potentially harmful effects of this response.68

This review summary assesses the benefits and harms of systemic corticosteroids in hospitalized patients with CAP. Patients received placebo or systemic corticosteroids ranging from a single dose to 10 days of treatment. Twelve studies of 1,974 patients demonstrated no statistically significant reduction in mortality, although there was a trend toward mortality reduction: 7.9% in the placebo group and 5.3% in the corticosteroid group (relative risk [RR] = 0.7; 95% confidence interval [CI], 0.5 to 1.0). Five studies of 1,060 patients demonstrated a 5% absolute risk reduction (number needed to treat [NNT] = 20) in mechanical ventilation (RR = 0.5; 95% CI, 0.3 to 0.8),

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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