Use of Corticosteroids for Pneumonia

• The use of corticosteroids in the management of pneumonia is still a controversial issue
• The evidence from trials taken separately is weak
• a Cochrane review and a systematic review found benefit using prolonged low doses of glucocorticoids in severe community-acquired pneumonia

Indication

• Based on limited data, indicated for pneumonia when a cortical insufficiency is diagnosed, or when Acute Lung Injury (ALI)/ARDS, severe sepsis, and/or severe pneumonia criteria are detectable
• In some studies, benefits of CS are ONLY seen in more severe pneumonia

Dose

• Benefit seen in prolonged courses of low dose corticosteroids (stress dose)
• The use of short-time high doses of corticosteroids should be discouraged in ICU patients because it is harmful
• Example: IV Hydrocortisone 200mg/day
• Example: Dexamethasone 5mg for 4 days

Duration

• Most of the trials adopted stress doses of glucorticoids for 4-7 days.
• A prolonged course, of at least 7-10 days
• Initiated within 12hours of onset of shock

Monitoring

• If corticosteroids are administered, infection surveillance, avoidance of neuromuscular blockers, and gradual taper of corticosteroids are recommended

References:

1. To use or not to use corticosteroids for pneumonia? A Clinician's Perspective
2. Association between systemic corticosteroids and outcomes of intensive care unit-acquired pneumonia. http://www.ncbi.nlm.nih.gov/pubmed/22732293
3. Adjuvant role of corticosteroids in the treatment of community-acquired pneumonia. http://www.sciencedirect.com/science/article/pii/S0422763813000356