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Corticosteroids supported for pneumonia

Community-acquired pneumonia is the leading infectious cause of death in developed countries, and despite advances in antibiotic treatment, mortality among hospitalised patients is still high, especially in those with severe pneumonia and in those who experience treatment failure (observed in 10-20% of patients). Science Daily reports that treatment failure is associated with excessive inflammatory response and worse outcomes. Corticosteroids decrease the expression and action of many cytokines (various proteins secreted by cells of the immune system that serve to regulate the immune system) involved in the inflammatory response associated with pneumonia, but the benefit of using corticosteroids for these patients is uncertain.

Dr Antoni Torres, of the Hospital Clinic, Barcelona, Spain, and colleagues randomly assigned patients at three Spanish teaching hospitals with severe community-acquired pneumonia and a high inflammatory response (defined as blood test for C-reactive protein of greater than 150 mg/L at admission) to receive intravenously the corticosteroid methylprednisolone (n = 61) or placebo (n = 59) for 5 days started within 36 hours of hospital admission.

The researchers found that there was less treatment failure (defined using outcomes such as development of shock (abnormally low blood pressure), need for invasive mechanical ventilation, and death within 72 hours of treatment) among patients from the methylprednisolone group (13% compared with 31% in the placebo group). Patients who received corticosteroid treatment had a 66% lower odds of treatment failure.

In-hospital deaths did not differ between groups (10% in the methylprednisolone group vs 15% in the placebo group). Hyperglycaemia (abnormally high blood sugars) occurred in 11 patients (18%) in the methylprednisolone group and in 7 patients (12%) in the placebo group.

"Among patients with severe community-acquired pneumonia and high initial inflammatory response, the acute use of methylprednisolone compared with placebo decreased treatment failure. If replicated, these findings would support the use of corticosteroids as adjunctive treatment in this clinical population," the authors write.

[link url="http://www.sciencedaily.com/releases/2015/02/150217114001.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Ftop_news%2Ftop_health+%28ScienceDaily%3A+Top+Health+News%29"]Full Science Daily report[/link]
[link url="http://jama.jamanetwork.com/article.aspx?articleid=2110967"]JAMA abstract[/link]

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