Advertisement
Previous article
Family Medicine Research Is Not a Federal Priority
Dec 2023
Next article
Spinal Cord Stimulation for Low Back Pain
Medicine by the Numbers

Adjunctive Corticosteroids for Severe Community-Acquired Pneumonia

Brit Long, MD,
Brooke Army Medical Center, Fort Sam Houston, Houston, Texas
Michael Gottlieb, MD,
Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois

American Family Physician. 2023;108(6):541D-541F.

Author disclosure: No relevant financial relationships.

Details for This Review

Study Population: 1,689 adult patients with severe community-acquired pneumonia (CAP) from seven randomized controlled trials (RCTs) comparing adjunctive corticosteroids with placebo or standard care

Efficacy End Points: 30-day, all-cause mortality; requirement for mechanical ventilation; length of intensive care unit (ICU) stay; length of hospital stay

Harm End Points: Adverse events, including gastrointestinal bleeding, health care–associated infection, acute kidney injury, and hospital readmission

THE NUMBERS

BenefitsHarms
1 in 16 had lower risk of 30-day, all-cause mortalityNo harms; no significant difference reported for any adverse events (e.g., gastrointestinal bleeding, health care–associated infection, acute kidney injury, hospital readmission)
1 in 7 had lower risk of requiring mechanical ventilation
Reduced length of intensive care unit stay (mean difference = −0.8 day)
Reduced length of hospital stay (mean difference = −1.1 day)

Narrative: Severe CAP is a leading cause of sepsis, hospitalization, and mortality, particularly in older patients, those with significant comorbidities, and those who are immunocompromised1–4 (Table 13 ). Primary treatment for CAP involves administering antimicrobials, and several RCTs have suggested that adjunctive corticosteroids may improve patient outcomes in those with severe CAP.5–10 However, prior systematic reviews and meta-analyses have not always included patients with severe CAP, and results have varied.11–13 One 2023 RCT investigating patients with severe CAP demonstrated reduced 28-day mortality with corticosteroids compared with placebo,14 which was not demonstrated in prior meta-analyses. Current guidelines differ from previous recommendations regarding the use of adjunctive corticosteroids in patients with severe CAP.3,4,15

Author disclosure: No relevant financial relationships.

  1. 1.Aliberti S, Dela Cruz CS, Amati F, et al. Community-acquired pneumonia. Lancet. 2021;398(10303):906-919.
  2. 2.Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415-427.
  3. 3.Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
  4. 4.Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(suppl 2):S27-S72.
  5. 5.Marik P, Kraus P, Sribante J, et al. Hydrocortisone and tumor necrosis factor in severe community-acquired pneumonia. A randomized controlled study. Chest. 1993;104(2):389-392.
  6. 6.Confalonieri M, Urbino R, Potena A, et al. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med. 2005;171(3):242-248.
  7. 7.Sabry NA, Omar EE-D. Corticosteroids and ICU course of community acquired pneumonia in Egyptian settings. Pharmacol Pharmacy. 2011;2(2):73-81.
  8. 8.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.
  9. 9.Meduri GU, Shih M-C, Bridges L, et al.; ESCAPe Study Group. Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia. Intensive Care Med. 2022;48(8):1009-1023.
  10. 10.El-Ghamrawy AH, Shokeir MH, Esmat AA. Effects of low-dose hydrocortisone in ICU patients with severe community-acquired pneumonia. Egypt J Chest. 2006;55:91-99.
  11. 11.Huang J, Guo J, Li H, et al. Efficacy and safety of adjunctive corticosteroids therapy for patients with severe community-acquired pneumonia: a systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e14636.
  12. 12.Stern A, Skalsky K, Avni T, et al. Corticosteroids for pneumonia. Cochrane Database Syst Rev. 2017(12):CD007720.
  13. 13.Saleem N, Kulkarni A, Snow TAC, et al. Effect of corticosteroids on mortality and clinical cure in community acquired pneumonia: a systematic review, meta-analysis, and meta-regression of randomized control trials. Chest. 2023;163(3):484-497.
  14. 14.Dequin P-F, Meziani F, Quenot J-P, et al.; CRICS-TriGGERSep Network. Hydrocortisone in severe community-acquired pneumonia. N Engl J Med. 2023;388(21):1931-1941.
  15. 15.Boyles TH, Brink A, Calligaro GL, et al.; South African Thoracic Society; Federation of Infectious Diseases Societies of Southern Africa. South African guideline for the management of community-acquired pneumonia in adults [published correction appears in J Thorac Dis. 2018; 10(8): E673–E675]. J Thorac Dis. 2017;9(6):1469-1502.
  16. 16.Wu J-Y, Tsai Y-W, Hsu W-H, et al. Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2023;27(1):274.
  17. 17.Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243-250.

Copyright ©2026 MD Aware, LLC (theNNT.com). Used with permission.

This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at https:// www.aafp.org/afp/mbtn.

Previous article
Family Medicine Research Is Not a Federal Priority
Dec 2023
Next article
Spinal Cord Stimulation for Low Back Pain

Current issue

September 2026

September 2026

Copyright © 2026 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. See permissions for copyright questions and/or permission requests.