Adjunctive corticosteroid therapy for adults hospitalized with community-acquired pneumonia (CAP) reduces the length of the hospital stay, according to the results of a systematic review and meta-analysis. However, such therapy does not alter mortality.
“We are that much closer to uncovering the mysterious relationship between steroids and pneumonia,” lead author Majid Shafiq, MD, Assistant Professor of Medicine in the Division of General Internal Medicine at the Johns Hopkins Hospital in Baltimore, told ConsultantLive.
At the same time, Dr Shafiq seeks to discourage primary care physicians from generalizing these exciting new findings. “Bear in mind that steroids may not be indicated for everyone,” he said.
Pneumonia poses a major health risk, especially in older patients, the very young, and those with chronic lung diseases. Up to 15% of patients with the condition die from it, depending on severity and the treatment administered.
Dr Shafiq, who conducted the research when he was at the Mayo Clinic College of Medicine in Rochester, Minnesota, and his colleagues identified 8 randomized controlled trials that included more than 1100 patients to examine the impact of corticosteroid therapy on clinical outcomes among adults admitted with CAP.
Adjunctive corticosteroid therapy had no effect on hospital mortality or length of stay in the intensive care unit but reduced the overall length of hospital stay by 1.21 days.
Speedy recovery from CAP is important because “many physicians may not realize that CAP is the leading infectious cause of death among U S adults. According to one study, more patients get admitted through the Emergency Room with pneumonia than with any other medical illness,” said Dr Shafiq. “The Centers for Disease Control reports that, on average, a patient spends 5 days or more in the hospital once admitted with pneumonia. Imagine the health and economic benefits if we could bring about a speedy recovery for a disease that is so common.”
Dr Shafiq recommends that physicians shun the conventional wisdom of temporarily stopping corticosteroid therapy among patients with pneumonia who happen to take corticosteroids for other ailments, such as lupus or Crohn disease.
“At the very least, it appears that steroids do not cause harm in these patients,” he said. “On the other hand, I would advise caution against routinely adding steroids to the medication profile of those who are not taking them to begin with. That is because it is reasonable to entertain the doubt that steroids do not impart any significant benefit, even though the aggregated research to date suggests otherwise.”
“In medicine we like to be highly conservative about giving additional medications because we hold the principle of ‘first, do no harm’ very dearly,” Dr Shafiq said. “If something doesn't clearly benefit the patient, it’s usually not worth the risk of side effects. So far, the scientific data do not justify a blind approach of providing steroids for everyone.”
The next step is to design a large, multicenter, carefully constructed clinical trial based on the findings and recommendations laid out in the research, Dr Shafiq added.
The researchers reported their results in the March issue of the Journal of Hospital Medicine.