The addition of corticosteroids to antibiotics might reduce disease severity and help patients with community-acquired pneumonia (CAP) recover more quickly than treatment with antibiotics alone. These are the findings of the largest trial to investigate corticosteroid treatment in patients hospitalised with CAP to date, published Online First in The Lancet.
Currently, treatment for CAP (an inflammatory condition of the lung) is limited to early diagnosis and antibiotic therapy, and associated mortality, morbidity, and health-care costs are high. Corticosteroids are often used to treat inflammatory states, such as sepsis, that are related to infections, but only a few recent trials have examined the addition of these steroid hormones to antibiotics as a potential treatment for pneumonia, with conflicting results.
To assess whether use of the corticosteroid dexamethasone might result in faster recovery (and reduce length of hospitalisation) by lessening airway inflammation, a Dutch team led by Sabine Meijvis from St Antonius Hospital in Nieuwegein, The Netherlands enrolled 304 patients admitted to hospital with CAP and randomly assigned them to usual antibiotic treatment plus either low-dose dexamethasone (5 mg once a day; 151 patients) or placebo (153 patients) for 4 days.Patients given dexamethasone recovered faster and had a more rapid decline in their blood c-reactive protein (CRP) and interleukin-6 levels, indicating less inflammation in their lungs.
Compared with standard treatment, dexamethasone reduced the length of hospital stay by one day (6.5 days vs 7.5 days) and significantly improved social functioning by day 30, without an increase in severe adverse side effects or hospital mortality.
The authors conclude: "Although serious adverse events were rare, one patient in the dexamethasone group developed a gastric perforation on day 3…[and] hyperglycaemia was noted more often in the dexamethasone group…The benefits of corticosteroids should be weighed against the potential disadvantages of these drugs, such as superinfections and gastric disturbances."
In a Comment, Marco Confalonieri from the University Hospital of Trieste, Trieste, Italy and G Umberto Meduri from Memphis VA Medical Center and University of Tennessee Health Science Center, Memphis, USA say: "The cost saving associated with reduction in hospital stay for this common disease has important public health relevance."
They add: "For the foreseeable future, glucocorticoids—with their rapid and profound anti-inflammatory effect, safety profile, and low cost—will remain the most viable candidate for first-line adjunctive treatment."
Ms Sabine Meijvis, St Antonius Hospital, Nieuwegein, The Netherlands. T) +31 (0) 6 13419325 (mobile) E) s.meijvis@antoniusziekenhuis.nl
Dr Marco Confalonieri, University Hospital of Trieste, Trieste, Italy. T) +39 (0) 40 3994665 or +39 3356895168 (mobile) E) marco.confalonieri@aots.sanita.fvg.it
Journal
The Lancet