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Effect of corticosteroids on the clinical course of community-acquired pneumonia: a randomized controlled trial

Silvia Fernández-Serrano1, Jordi Dorca12*, Carolina Garcia-Vidal34, Núria Fernández-Sabé3, Jordi Carratalà34, Ana Fernández-Agüera13, Mercè Corominas5, Susana Padrones1, Francesc Gudiol34 and Frederic Manresa1

Author Affiliations

1 Respiratory Medicine Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain

2 CIBER de Enfermedades Respiratorias ISCIII, Madrid, Spain (Spanish Network for the Research in Respiratory Diseases), Recinto Hospitalario Joan March, Carretera Sóller Km 12; 07110 Bunyola, Mallorca, Spain

3 Infectious Disease Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain

4 REIPI (Spanish Network for the Research in Infectious Diseases), Fundación Reina Mercedes, Edificio de los laboratorios 6a pl; Av. Manuel Siurot s/n; 41013 Sevilla, Spain

5 Immunology Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain

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Critical Care 2011, 15:R96  doi:10.1186/cc10103


See related commentary by Salluh et al., http://ccforum.com/content/15/2/137

Published: 15 March 2011

Abstract

Introduction

The benefit of corticosteroids as adjunctive treatment in patients with severe community-acquired pneumonia (CAP) requiring hospital admission remains unclear. This study aimed to evaluate the impact of corticosteroid treatment on outcomes in patients with CAP.

Methods

This was a prospective, double-blind and randomized study. All patients received treatment with ceftriaxone plus levofloxacin and methyl-prednisolone (MPDN) administered randomly and blindly as an initial bolus, followed by a tapering regimen, or placebo.

Results

Of the 56 patients included in the study, 28 (50%) were treated with concomitant corticosteroids. Patients included in the MPDN group show a more favourable evolution of the pO2/FiO2 ratio and faster decrease of fever, as well as greater radiological improvement at seven days. The time to resolution of morbidity was also significantly shorter in this group. Six patients met the criteria for mechanical ventilation (MV): five in the placebo group (22.7%) and one in the MPDN group (4.3%). The duration of MV was 13 days (interquartile range 7 to 26 days) for the placebo group and three days for the only case in the MPDN group. The differences did not reach statistical significance. Interleukin (IL)-6 and C-reactive protein (CRP) showed a significantly quicker decrease after 24 h of treatment among patients treated with MPDN. No differences in mortality were found among groups.

Conclusions

MPDN treatment, in combination with antibiotics, improves respiratory failure and accelerates the timing of clinical resolution of severe CAP needing hospital admission.

Trial Registration

International Standard Randomized Controlled Trials Register, ISRCTN22426306.