Study of the Efficacy and Safety of Antioxidants Astaxanthin as an Adjuvant Therapy for Community Acquired Pneumonia Patients.

Community acquired pneumonia (CAP) is one of the most common and morbid conditions encountered in clinical practice, which causes serious morbidity worldwide. In CAP, oxidative stress is linked to inflammation, demonstrated by increased production of interleukin (IL)-6 and tumor necrosis factor (TNF)-α, which attract inflammatory cells and increase oxidant production by these cells. Attenuation of oxidative stress via antioxidants would be expected to result in reduced pulmonary damage. Antioxidants have been found to be effective in alleviating lung injury and protecting against damage of other organs.

The study will be randomized controlled trial, that will be carried out at ICU at El Matarya Teaching Hospital.

Prior to participation in the study, written informed consent will be obtained from the patients or their family.

Patients with the following criteria will be enrolled: age ≥ 18 year, having clinical symptoms suggestive of CAP such as cough (with or without sputum), fever (\> 38.5°C), pleuritic chest pain or dyspnea and consolidations on computed Tomography (CT). Patients will be excluded from the study if having one of the following criteria: advanced age (≥70 years old), presence of severe immunosuppression (HIV infection, use of immune suppressants), malignancy, other concurrent infections, obstruction pneumonia (e.g., because of lung cancer), pneumonia developed within two weeks after hospital discharge, use of ASX before study entry, hypersensitivity to ASX, taking warfarin, taking other antioxidants such as vitamin C, vitamin E, glutathione, granulocytopenia (\<1000 neutrophils/mm3), renal failure, liver failure, pregnant and lactating women, hemodynamically unstable patients.

Eligible CAP patients at El Matarya Teaching Hospital will be randomly assigned to either ASX group or control group. The ASX group will receive ASX (12mg/d) orally or enterally in addition to conventional therapy for CAP. \[1,2\] The control group will receive placebo orally or enterally in addition to conventional therapy for CAP. \[2\] The treatment duration will be from hospital admission till time of discharge for each CAP patient.

All patients will be subjected to the following:

A. Patient Data Collection:

1. Baseline characteristics: demographic data of the participants including: age, gender, weight, height, and body mass index (BMI).
2. Medication History: complete history of medication will be recorded for each patient including medications for comorbidities and past medication history as well as concomitant medications.
3. Medical History: patient history will be recorded including history of present illness as well as comorbidities.

B. Clinical Assessment:

1. Physical Examination: daily records of ABGS, body temperature, pulse, blood pressure, and respiratory rate will be collected, baseline and final readings will be used for analysis.
2. Biochemical Investigations:

2.1 The biochemical parameters include complete blood count with differential counts of total leukocyte count, lymphocytic count, liver function, renal functions, albumin level, creatinine level, alkaline phosphatase level, ferritin level, C-reactive protein, Prothrombin time (PT), activated partial thromboplastin time APTT, lipid profile and blood sugar level , baseline and final readings will be used for analysis.

2.2 Cytokine storm parameters (interleukin-6, tumor necrosis factor-α, and interleukin10) will be assessed at baseline and at the end of the study.

C. Severity Assessment: CURB-65 severity score that has been validated for predicting mortality of CAP, will be assessed at baseline and at the end of the study.\[3\] D. Radiological Assessment of CAP: computed tomography will be carried out before enrollment to confirm pneumonia diagnosis.

Eligibility Criteria:
Inclusion Criteria:

* Age ≥ 18 year
* Clinical: Having symptoms suggestive of CAP such as cough (with or without sputum), fever (\> 38.5°C), pleuritic chest pain or dyspnea.
* Radiologic: consolidations on computed Tomography (CT).

Exclusion Criteria:

* Advanced age (≥70 years old). Presence of severe immunosuppression (HIV infection, use of immune suppressants).

Malignancy. Other concurrent infections, obstruction pneumonia (e.g., because of lung cancer).

Pneumonia developed within two weeks after hospital discharge. Use of ASX before study entry. Hypersensitivity to ASX. Taking warfarin.

* Taking other antioxidants such as vitamin C, vitamin E, glutathione.
* Granulocytopenia (\<1000 neutrophils/mm3).
* Renal failure.
* Liver failure.
* Pregnant and lactating women.
* Hemodynamically unstable patients.