Guide to Steroid Use in Community-Acquired Pneumonia
Pharmacists and physicians are seeing more recommendations for using steroids in patients hospitalized with community-acquired pneumonia (CAP). Recognize that inflammation in the lungs significantly contributes to pneumonia symptoms. Small trials offer mixed results on steroid benefits, but guidelines still don't recommend their use universally.
Note recent studies suggesting that hospitalized CAP patients treated with prednisone 50 mg daily for seven days achieve stability 1.5 days sooner and switch to PO antibiotics a day earlier. This approach might also allow discharge one day sooner.
Use steroids for immunocompetent floor patients but not for those treated in the community or ICU. Recommend adjunctive steroids for CAP patients exhibiting an exaggerated inflammatory response, including sepsis or respiratory failure with an FiO2 > 50% and any of the following:
- Metabolic acidosis with arterial pH < 7.3
- Lactate > 4 mmol/L
- C-reactive protein (CRP) > 150 mg/L
Treat with steroids for five days. For patients unable to take oral medications, suggest methylprednisolone (Solu-Medrol, etc) 0.5 mg/kg IV every 12 hours. For those able to take oral medications, recommend prednisone (Solupred, etc) 50 mg orally daily.
Avoid steroids in CAP patients with known viral pathogens like influenza or fungal pathogens like Aspergillus. Use tools like the Pneumonia Severity Index to guide admission decisions and appropriate patient placement. Ensure proper monitoring of patients on steroids, as one in 13 may require corrective insulin for high blood glucose. Since most patients won't remain hospitalized for seven days, provide a prescription to complete the steroid course upon discharge.
Take-home points
- Consider using steroids for hospitalized CAP patients to reduce inflammation and speed up recovery.
- Recommend a seven-day course of steroids to promote patient stability. Administer methylprednisolone 0.5 mg/kg IV every 12 hours for those unable to take oral steroids. For patients able to take oral medications, suggest prednisone 50 mg orally daily.
- Avoid steroids in CAP patients with known viral or fungal pathogens.
- Use the Pneumonia Severity Index to guide hospital admission and patient placement decisions and Monitor patients on steroids closely, as one in 13 may need corrective insulin for high blood glucose.
References
- Blum CA, Nigro N, Briel M, et al. Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial. Lancet. 2015;385(9977):1511-1518. doi:10.1016/S0140-6736(14)62447-8
- Annane D. Corticosteroids and pneumonia: time to change practice. Lancet. 2015;385(9977):1484-1485. doi:10.1016/S0140-6736(14)62391-6
- Shafiq M, Mansoor MS, Khan AA, Sohail MR, Murad MH. Adjuvant steroid therapy in community-acquired pneumonia: a systematic review and meta-analysis. J Hosp Med. 2013;8(2):68-75. doi:10.1002/jhm.1992
- Chen Y, Li K, Pu H, Wu T. Corticosteroids for pneumonia. Cochrane Database Syst Rev. 2011;(3):CD007720. Published 2011 Mar 16. doi:10.1002/14651858.CD007720.pub2
Keywords: Steroids for CAP treatment, Prednisone in pneumonia, Adjunctive steroids in hospital, CAP management guidelines, Inflammation in community-acquired pneumonia
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