Corticosteroids for Severe Community-Acquired Pneumonia: Time to Change Clinical Practice
Authors: Marcos I. Restrepo, Antonio Anzueto, Antoni Torres
Journal: Annals of Internal Medicine (2015)

Editorials6 October 2015Corticosteroids for Severe Community-Acquired Pneumonia: Time to Change Clinical PracticeMarcos I. Restrepo, MD, MSc, Antonio Anzueto, MD, and Antoni Torres, MD, PhDMarcos I. Restrepo, MD, MScFrom University of Texas Health Science Center at San Antonio, San Antonio, Texas, and Servei de Pneumologia, Institut Clínic del Torax, Hospital Clínic, Barcelona, Spain.Search for more papers by this author, Antonio Anzueto, MDFrom University of Texas Health Science Center at San Antonio, San Antonio, Texas, and Servei de Pneumologia, Institut Clínic del Torax, Hospital Clínic, Barcelona, Spain.Search for more papers by this author, and Antoni Torres, MD, PhDFrom University of Texas Health Science Center at San Antonio, San Antonio, Texas, and Servei de Pneumologia, Institut Clínic del Torax, Hospital Clínic, Barcelona, Spain.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-1805 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease.—Sir William OslerCommunity-acquired pneumonia (CAP) is a leading cause of hospitalization, morbidity, and mortality (1, 2). Systemic adjunctive corticosteroid therapy in patients with CAP has been shown to affect local and systemic inflammatory response (3) and may decrease the frequency of the acute respiratory distress syndrome (ARDS), sepsis, and mortality, but its use is controversial (4). Over the past decade, several randomized, ...References1. DeFrances CJ, Lucas CA, Buie VC, Golosinskiy A. 2006 National Hospital Discharge Survey. Natl Health Stat Report. 2008:1-20. MedlineGoogle Scholar2. Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al; CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015. [PMID: 26172429] MedlineGoogle Scholar3. Montón C, Ewig S, Torres A, El-Ebiary M, Filella X, Rañó A, et al. Role of glucocorticoids on inflammatory response in nonimmunosuppressed patients with pneumonia: a pilot study. Eur Respir J. 1999;14:218-20. [PMID: 10489855] CrossrefMedlineGoogle Scholar4. Sibila O, Ferrer M, Agustí C, Torres A. Corticosteroids as adjunctive treatment in community-acquired pneumonia. Minerva Anestesiol. 2014;80:1336-44. [PMID: 24518215] MedlineGoogle Scholar5. Confalonieri M, Urbino R, Potena A, Piattella M, Parigi P, Puccio G, et al. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med. 2005;171:242-8. [PMID: 15557131] CrossrefMedlineGoogle Scholar6. Snijders D, Daniels JM, deGraaff CS, van der Werf TS, Boersma WG. Efficacy of corticosteroids in community-acquired pneumonia: a randomized double-blinded clinical trial. Am J Respir Crit Care Med. 2010;181:975-82. [PMID: 20133929] doi:10.1164/rccm.200905-0808OC CrossrefMedlineGoogle Scholar7. Siemieniuk RAC, Meade MO, Alonso-Coello P, Briel M, Evaniew N, Prasad M, et al. Corticosteroid therapy for patients hospitalized with community-acquired pneumonia.A systematic review and meta-analysis. Ann Intern Med. 2015;163:519-28. doi:10.7326/M15-0715 LinkGoogle Scholar8. Menéndez R, Martínez R, Reyes S, Mensa J, Filella X, Marcos MA, et al. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax. 2009;64:587-91. [PMID: 19131448] doi:10.1136/thx.2008.105312 CrossrefMedlineGoogle Scholar9. Chalmers JD, Smith MP, McHugh BJ, Doherty C, Govan JR, Hill AT. Short- and long-term antibiotic treatment reduces airway and systemic inflammation in non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2012;186:657-65. [PMID: 22744718] doi:10.1164/rccm.201203-0487OC CrossrefMedlineGoogle Scholar10. Torres A, Sibila O, Ferrer M, Polverino E, Menendez R, Mensa J, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA. 2015;313:677-86. [PMID: 25688779] doi:10.1001/jama.2015.88 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Texas Health Science Center at San Antonio, San Antonio, Texas, and Servei de Pneumologia, Institut Clínic del Torax, Hospital Clínic, Barcelona, Spain.Disclaimer: The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health.Financial Support: Dr. Torres's time is partially protected by Sociedad Española de Neumología, Societat Catalana de Pneumologia, Fundació Catalana de Pneumologia, Grup de recerca de qualitat de la Generalitat de Catalunya, Fondo de Investigación Sanitaria (PI030113), Institut D'ínvestigació August Pi i Sunyer, and Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CB06/06/0028). Dr. Restrepo's time is partially protected by award number K23HL096054 from the National Heart, Lung, and Blood Institute.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1805.Corresponding Author: Antonio Anzueto, MD, University of Texas Health Science Center at San Antonio, 7400 Merton Minter Boulevard, San Antonio, TX 78229; e-mail, [email protected]edu.Current Author Addresses: Drs. Restrepo and Anzueto: University of Texas Health Science Center at San Antonio, 7400 Merton Minter Boulevard, San Antonio, TX 78229.Dr. Torres: Servei de Pneumologia i Allèrgia Respiratòria, Hospital Clínic de Barcelona, Calle Villarroel, 170, 08036 Barcelona, Spain.This article was published online first at www.annals.org on 11 August 2015. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCorticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia Reed A.C. Siemieniuk , Maureen O. Meade , Pablo Alonso-Coello , Matthias Briel , Nathan Evaniew , Manya Prasad , Paul E. Alexander , Yutong Fei , Per O. Vandvik , Mark Loeb , and Gordon H. Guyatt Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia Reed A.C. Siemieniuk , Maureen O. Meade , Pablo Alonso-Coello , Matthias Briel , Nathan Evaniew , Manya Prasad , Paul E. Alexander , Yutong Fei , Per O. Vandvik , Mark Loeb , and Gordon H. Guyatt Metrics Cited byAntimicrobial Therapy in the Context of the Damage-Response Framework: the Prospect of Optimizing Therapy by Reducing Host DamageA Non-Human Primate Model of Severe Pneumococcal PneumoniaCommunity-acquired pneumoniaCorticosteroids for community-acquired pneumonia: a critical view of the evidence 6 October 2015Volume 163, Issue 7Page: 560-561KeywordsAcute respiratory distress syndromeC-reactive proteinsClinical trialsCorticosteroid therapyMortalityPneumoniaSystematic reviewsSystemic inflammatory response syndromeVasopressorsVentilators ePublished: 6 October 2015 Issue Published: 6 October 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...