Table 2.
Main clinical findings concerning the role of corticosteroids in the treatment of community-acquired pneumonia (CAP)
Authors and year | Number of cases (patients/controls) | Mean age (years) | Type of CAP | Intervention | Co-intervention | Main outcomes |
---|---|---|---|---|---|---|
McHardy and Schonell, 1972 [43] | 40/86 | 56.7–64.3 | Clinical or radiographically confirmed CAP | Prednisolone PO 20 mg/day for 7 days | Ampicillin various dosages | Death; duration of treatment; change of treatment; resolution of temperature; clearance of pathogens from sputum or laryngeal swabs |
Marik et al., 1993 [45] | 14/16 | Over 30 | CAP requiring admission to ICU | Hydrocortisone 10 mg/kg for 1 day | Antibiotics i.v. | TNF-α levels; length of stay in ICU, APACHE score; mortality |
Confalonieri et al., 2005 [46] | 24/24 | Over 60 | CAP requiring admission to ICU | Hydrocortisone 200 mg as bolus followed by hydrocortisone 240 mg in 500 saline at a rate of 10 mg/h for 7 days | Protocol-guided antibiotic treatment | Improvement in PaO2:FiO2; multiple organ dysfunction syndrome score by study day 8; development of delayed septic shock; duration of mechanical ventilation; length of ICU and hospital stay; survival until hospital discharge and for 60 days after discharge |
Mikami et al., 2007 [47] | 15/16 | Over 70 | CAP not requiring mechanical ventilation; sputum culture positive for bacteria in 39 % of the patients | Prednisolone 40 mg i.v. daily for 3 days | Antibiotics i.v., mainly macrolides | Length of hospital stay; duration of i.v. antibiotic treatment; time required to stabilise vital signs |
Snijders et al., 2010 [48] | 104/109 | Over 60 | Radiographically confirmed CAP of various degrees of severity | Prednisolone 40 mg daily for 7 days, initially i.v., then PO when antibiotics were switched from i.v. to PO | Antibiotics i.v. followed by PO | Clinical cures after 7 and 30 days; length of hospitalisation; time to clinical stability, defervescence and C-reactive protein normalisation |
Fernández-Serrano et al., 2011 [49] | 28/28 | Over 60 | Severe CAP | 200 mg of methylprednisolone, 30 min before starting antibiotic treatment. Thereafter, a maintenance intravenous dose (20 mg/6 h) for 3 days, then 20 mg/12 h for 3 days and, finally, 20 mg/day for a further 3 days | 1 g/day of ceftriaxone and 500 mg/day of levofloxacin i.v. | Respiratory failure requiring conventional MV or non-invasive positive pressure ventilation; benefit in terms of an improved clinical course as measured by the PaO2/FiO2 ratio, radiological improvement; TRM score; length of hospital stay; length of ICU stay; mortality; decreasing levels of systemic inflammatory response (IL-6, TNF-α, IL-8, IL-10 and CRP) |
Meijvis et al., 2011 [50] | 151/153 | Over 60 | Radiographically confirmed CAP not requiring admission to ICU | Dexamethasone 5 mg i.v. once a day for 4 days | Various antibiotics | Length of hospital stay; mortality; admission to ICU; development of empyema; superinfection; re-admission; time courses of CRP, IL-6 and IL-10 concentrations; pulmonary function after 30 days |
Remmelts et al., 2012 [51] | 131/144 | Over 60 | Radiographically confirmed CAP not requiring admission to ICU | Dexamethasone 5 mg/day i.v. for 4 days | Various antibiotics | Need for ICU admission; mortality; duration of hospital stay |
Tamura et al., 2008 [52] | 6/no controls (retrospective study) | 5.8 | Refractory M. pneumoniae CAP | Methylprednisolone 30 mg/kg i.v. once daily for 3 days | A macrolide not stated | Improvement in clinical and radiological findings |
Lee et al., 2006 [53] | 15/no controls (retrospective study) | 6.1 | Refractory M. pneumoniae CAP | Prednisone 1 mg/kg PO for 3–7 days | A macrolide not stated | Improvement in clinical and radiological findings |
Weiss et al., 2011 [54] | 7,234/13,472 (retrospective study) | 4 | All types of CAP | Type and dose of corticosteroids not stated | Antibiotics in most cases; chronic asthma medication in 31.8 % of those receiving systemic steroids | Length of hospital stay |
CRP C-reactive protein; ICU intensive care unit; i.v. intravenous delivery; MV mechanical ventilation; PO oral delivery