1 Jan 2024 • For many years, clinicians have wondered if glucocorticoids also could be beneficial in community-acquired pneumonia (CAP) because of their anti-inflammatory properties.

• In a study published in 2023, French investigators randomized 800 patients with severe CAP to receive either intravenous hydrocortisone (200 mg daily) or placebo.
• All patients were admitted to the intensive care unit (ICU) and began treatment within 24 hours of developing severe CAP.
• In this critically ill population, mortality was significantly lower with hydrocortisone than with placebo (6% vs. 12%); the incidence of shock and need for mechanical ventilation also were lower in the hydrocortisone group.
• After the French trial was published, investigators performed a meta-analysis of 15 corticosteroid trials that involved more than 3000 patients hospitalized for CAP.
• Progression to acute respiratory distress syndrome (ARDS) was less likely among patients who received steroids.

Based on the above findings, it appears rational to administer moderate-dose steroids early to the most critically ill patients. As a result, there is now a heightened inclination to initiate glucocorticoid treatment at an earlier stage for ICU patients and adoption for a similar strategy for patients on higher levels of supplemental oxygen admitted to a general ward.

Source: NEJM J-Watch | Read full story