When should we use corticosteroids in severe community-acquired pneumonia?

Pedro Póvoa, Luís Coelho, Jorge Salluh

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Abstrakt

PURPOSE OF REVIEW: This review aims to evaluate the evidence and recommendations for the prescription of corticosteroids as adjunctive therapy in patients with severe community-acquired pneumonia. RECENT FINDINGS: Corticosteroids have been prescribed with the objective to attenuate the marked and persistent activation of the immune system. However, some causes of community-acquired pneumonia, namely viral, are associated with unexpected low levels of cytokines and depressed cellular immunity. As a result, several recent randomized controlled trials and large prospective observational studies repeatedly showed that corticosteroids had no impact on survival, and in some types of pneumonia like influenza, its use was associated with potential harmful effects like invasive aspergillosis. Apart from this, adverse effects, namely hyperglycemia, superinfections and increased length-of-stay, were frequent findings in the corticosteroid-treated patients. SUMMARY: According to the current evidence, corticosteroids are recommended in Pneumocystis jiroveci pneumonia in HIV-infected patients and recommendations are against its use in influenza. In all other forms of severe community-acquired pneumonia, with the exclusion of SARS-CoV-2 pneumonia, the strength of the evidence does not support the safe and widespread use of corticosteroids as adjunctive therapy. Further studies are needed to identify subgroups of severe community-acquired pneumonia that can benefit or not from corticosteroids.

OriginalsprogEngelsk
TidsskriftCurrent Opinion in Infectious Diseases
Vol/bind34
Udgave nummer2
Sider (fra-til)169-174
ISSN0951-7375
DOI
StatusUdgivet - 1. apr. 2021

Bibliografisk note

Publisher Copyright:
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Copyright:
This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine

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