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. 2012 Sep 21;32(2):151–160. doi: 10.1007/s10096-012-1747-y

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