Clinical Question

Does adding prednisone to antibiotics improve outcomes in adults hospitalized with community-acquired pneumonia (CAP)?

Bottom Line

Among patients hospitalized with CAP, adjunctive prednisone speeds time to recovery by 1.5 days and shortens hospital length of stay by approximately one day, but produces no difference in pneumonia complications at 30 days. (Level of Evidence = 1b)

Synopsis

In this Swiss study, patients admitted to the hospital with CAP randomly received 50 mg of prednisone daily for seven days (n = 402) or placebo (n = 400). Each day, a researcher unaware of treatment assignment assessed the patients' clinical status. Patients treated with prednisone reached clinical stability (at least 24 hours of stable vital signs: afebrile, no tachycardia or tachypnea, normotensive, normal mental status, no hypoxia) approximately 1.5 days faster than patients treated with placebo. The average length of stay was one day longer in patients treated with placebo. The patients taking prednisone were more likely to have hyperglycemia treated with insulin.

Study design: Randomized controlled trial (double-blinded)

Funding source: Foundation

Allocation: Concealed

Setting: Inpatient (any location)

Reference: BlumCANigroNBrielMet alAdjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial. Lancet2015; 385( 9977): 1511– 1518.