Clinical question
Compared with antibiotics given with placebo or alone, how effective are corticosteroids (with antibiotics) in the treatment of community-acquired pneumonia (CAP)?
Bottom line
In adults with severe CAP, corticosteroids reduced mortality (NNT=18), clinical failure, complication rates, length of hospitalisation, and time to clinical cure. People with non-severe CAP might benefit from corticosteroid therapy as well, but with no survival advantage. Regarding the latter, caution is required for people with diabetes due to the effect of corticosteroids on glucose control. The quality of the evidence for these conclusions was mostly moderate. Corticosteroid therapy was associated with more adverse events, especially hyperglycaemia, but the harm did not seem to outweigh the benefits.
Caveat
Among children with bacterial pneumonia, corticosteroids reduced early clinical failure rates (high-quality evidence) based on two, small, clinically heterogeneous trials, and they reduced time to clinical cure.
Context
Pneumonia is a common and potentially serious illness. Corticosteroids have been suggested for the treatment of different types of infection; however, their role in the treatment of pneumonia remains unclear.
Cochrane Systematic Review
Stern A et al. Corticosteroids for pneumonia. Cochrane Reviews, 2017, Issue 12. Art. No.: CD007720.DOI: 10.1002/14651858. CD007720.pub3. This review contains 17 studies involving 2264 participants.
Cochrane Systematic Reviews for primary care practitioners – developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the Ministry of Health. Brian McAvoy is an honorary/adjunct professor of general practice at the Universities of Auckland, Melbourne, Monash and Queensland. New Zealanders can access the Cochrane Library free via nz.cochrane.org
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