A correction for this article has been published in Critical Care 2008, 12:434

Research

The role of corticosteroids in severe community-acquired pneumonia: a systematic review

Jorge IF Salluh^1,2 , Pedro Póvoa³ , Márcio Soares¹ , Hugo C Castro-Faria-Neto² , Fernando A Bozza⁴ and Patrícia T Bozza²

¹Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil, Praça Cruz Vermelha, 23, 10 andar – Centro, 20230-130 – Rio de Janeiro – RJ

²Immunopharmacology Laboratory, Instituto Oswaldo Cruz, FIOCRUZ, Av. Brasil, 4365, Rio de Janeiro-RJ, Brazil 21045-900

³Medical Intensive Care Unit, Hospital de São Francisco Xavier. Centro Hospitalar de Lisboa Ocidental. Estrada do Forte do Alto do Duque, CEP 1449-005 Lisboa, Portugal

⁴Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro-RJ, Brazil 21045-900

author email corresponding author email

Critical Care 2008, 12:R76doi:10.1186/cc6922

Published:	11 June 2008

See related commentary by Annane and Medori, http://ccforum.com/content/12/4/166

Abstract

Introduction

The purpose of this review was to evaluate the impact of corticosteroids on the outcomes of patients with severe community-acquired pneumonia (CAP).

Methods

We performed a systematic MEDLINE, Cochrane database, and CINAHL search (1966 to November 2007) to identify full-text publications that evaluated the use of corticosteroids in CAP.

Results

An initial literature search yielded 109 articles, and 105 studies were excluded after the first analysis. We found four studies eligible for analysis. On the basis of their results, the use of corticosteroids as adjunctive therapy in severe CAP should be categorized as a weak recommendation (two studies) and a strong recommendation (two studies) with either low- or moderate-quality evidence. However, no evidence of adverse outcomes or harm is present in the evaluated studies.

Conclusion

According to the GRADE system, available studies do not support the recommendation of corticosteroids as a standard of care for patients with severe CAP. Further randomized controlled trials with this aim should enroll a larger number of severely ill patients. However, in patients needing corticosteroids, it may be reasonable to conclude that corticosteroid administration is safe in patients with severe infections receiving antimicrobial therapy.