Dexamethasone for community acquired pneumonia

Another Dutch study has examined steroids for community acquired pneumonia, this time with the primary outcome measure being hospital length of stay, which was reduced by one day on the steroid group. Compare this study with a previous negative study of prednisolone for pneumonia.

BACKGROUND: Whether addition of corticosteroids to antibiotic treatment benefits patients with community-acquired pneumonia who are not in intensive care units is unclear. We aimed to assess effect of addition of dexamethasone on length of stay in this group, which might result in earlier resolution of pneumonia through dampening of systemic inflammation.

METHODS: In our double-blind, placebo-controlled trial, we randomly assigned adults aged 18 years or older with confirmed community-acquired pneumonia who presented to emergency departments of two teaching hospitals in the Netherlands to receive intravenous dexamethasone (5 mg once a day) or placebo for 4 days from admission. Patients were ineligible if they were immunocompromised, needed immediate transfer to an intensive-care unit, or were already receiving corticosteroids or immunosuppressive drugs. We randomly allocated patients on a one-to-one basis to treatment groups with a computerised randomisation allocation sequence in blocks of 20. The primary outcome was length of hospital stay in all enrolled patients. This study is registered with, number NCT00471640.

FINDINGS: Between November, 2007, and September, 2010, we enrolled 304 patients and randomly allocated 153 to the placebo group and 151 to the dexamethasone group. 143 (47%) of 304 enrolled patients had pneumonia of pneumonia severity index class 4-5 (79 [52%] patients in the dexamethasone group and 64 [42%] controls). Median length of stay was 6·5 days (IQR 5·0-9·0) in the dexamethasone group compared with 7·5 days (5·3-11·5) in the placebo group (95% CI of difference in medians 0-2 days; p=0·0480). In-hospital mortality and severe adverse events were infrequent and rates did not differ between groups, although 67 (44%) of 151 patients in the dexamethasone group had hyperglycaemia compared with 35 (23%) of 153 controls (p<0·0001).

INTERPRETATION: Dexamethasone can reduce length of hospital stay when added to antibiotic treatment in non-immunocompromised patients with community-acquired pneumonia.

Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial
Lancet. 2011 Jun 11;377(9782):2023-30

2 thoughts on “Dexamethasone for community acquired pneumonia”

  1. Hooray for the forward thinking open minded initiators of this study! It’s about time the medical community quit teaching the evil’s of low dose steroids and resume initiating the clinical and cost benefits of this longstanding well recognized and inexpensive class of drugs. It’s certainly not cost effective for drug companies to prove the efficacy and safety of steroids when used in low doses. Older research recently re-visited shows dex also helped prevent “bounce backs” in migraine admissions. I’m just a veterinarian, not particularly adept at surgery. My operating times and tissue handling are mediocre at best, but my outcomes are right up there with the best if I administer a loading dose of dex to all trauma victims, routine surgeries and other wounds. I’ve also had amazing results keeping adult to geriatric dogs ambulatory for years, when they’ve been unable to rise due to spinal issues not treatable by the neurosurgeons. Recent research in Europe has also shown that low dose steroids not only improve quality of life in arthritis patients, but evidence shows it prevents new onset, or progression! What would this due to the sale of the continuous influx of new non-steroidals? I wish someone would create a chart itemizing steroids and NSAIDS reflecting cost and side effect profiles at recommended doses for NSAiDS and “low dose” for steroids. I think it would show that steroids are safer and more effective. (dex < 5 mg / day short term; 1/2 mg / day long term (years). MD's and DVM's forget or are never taught that dex is a diuretic and should top the choices for all conditions where fluid levels are significant (asthma, pneumonia, localized swelling, renal disease to flush kidneys). Instead they're taught all the evils: most specifically delayed wound healing, increase suceptability to infection, and adrenal suppression. If these were so significant then I wish someone would explain to me why patients undergoing craniotomy heal so quickly without complication while on weeks of high dose steroids titrated off! Why do their incisions heal quickly without complications? Furthermore, why do transplant patients do so well who are maintained on low dose steroids and average dose antibiotics for years! It would certainly hurt the drug companies and save the health care communities billions if we thought critically at what's being taught. God help us when all the "old" mentors die.

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