Adjuvant role of corticosteroids in the treatment of community-acquired pneumonia

BackgroundDespite progress in life-support measures and antimicrobial therapy, the mortality of severe pneumonia has not varied since the mid-1990s, suggesting that other factors are of crucial importance in the evolution of this respiratory infection.ObjectiveTo evaluate the impact of hydrocortisone infusion in community-acquired pneumonia (CAP) in the attenuation of systemic inflammation and reduction of sepsis-related complications.MethodsThe study enrolled 80 patients, clinically and radiolodically diagnosed as community-acquired pneumonia, admitted to Chest department, Respiratory Intensive Care Unit, General Medicine Department and General Medicine Intensive Care Unit of Zagazig University Hospitals. Sixty of them were randomized to receive hydrocortisone as a bolus dose of 200 mg intravenously once (only at day 1) then 10 mg/h IV infusion for 7 days and twenty received placebo, along with antibiotics according to IDSA/ATS 2007 guidelines which were given for both groups. The following parameters were compared in both groups; PaO2 and PaO2/FiO2 ratio, length of hospital stay, duration of IV antibiotic treatment, duration of mechanical ventilation, weaning success from mechanical ventilation, pneumonia complication and hospital outcome.ResultsHydrocortisone treated patients showed a significant improvement in PaO2 and PaO2/FiO2 ratio, a significant reduction in White blood cell count, C-reactive protein levels, Erythrocyte sedimentation rate, a significant reduction in the duration of mechanical ventilation, duration of IV antibiotic treatment, pneumonia complications, and length of hospital stay. Also there was an improvement of hospital outcome, weaning success from mechanical ventilation and radiological resolution compared to the placebo group.ConclusionAdjunctive 7 day course of low dose hydrocortisone IV in patients with CAP hastens clinical recovery and prevents the development of sepsis-related complications with a significant reduction in the duration of mechanical ventilation, duration of IV antibiotics and length of hospital stay with the improvement in hospital outcome and weaning success from mechanical ventilation.