The addition of corticosteroids to antibiotics might reduce disease severity and help patients with community-acquired pneumonia (CAP) recover more quickly than with treatment using antibiotics alone, according to the [removed]findings[/removed] of the largest trial to investigate corticosteroid treatment in patients hospitalized with CAP to date. The findings appear in The Lancet.

Current treatment for CAP is limited to early diagnosis and antibiotic therapy. Corticosteriods 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 hospitalization—by lessening airway inflammation, researchers enrolled 304 patients admitted to the 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 versus 7.5 days) and significantly improved social functioning by day 30, without an increase in severe adverse side effects or hospital mortality.

The researchers note that while serious adverse events were rare—one patient in the dexamethasone group developed a gastric perforation on day 3 and hyperglycemia was seen more often in the dexamethasone group—the benefits of corticosteroids should be weighed against the potential disadvantages of these drugs.

Source: The Lancet