A bundled intervention that included corticosteroids did not improve outcomes and was associated with gastrointestinal bleeding.
Recent meta-analyses of randomized trials, including a Cochrane review (NEJM JW Hosp Med May 2018 and Cochrane Database Syst Rev 2017; 12:CD007720), show that corticosteroids significantly lower mortality, shorten hospital length of stay (LOS), and prevent complications for hospitalized patients with severe community-acquired pneumonia (CAP). However, this adjunctive treatment has yet to be implemented widely as standard clinical practice.
In a 1-year, double-blind, randomized trial in ≈800 adults (mean age, 75) who were hospitalized with CAP, Australian researchers evaluated the effectiveness of a bundle of evidence-supported treatments:
Reviewing Author
DisclosuresConsultant/Advisory BoardNEJM Healer Advisory Group; Aquifer Clinical Excellence; NBME Clinical Reasoning
Grant/Research SupportSouthern Group on Educational Affairs (SGEA)
Editorial BoardsDiagnosis
Leadership Positions in Professional SocietiesUndergraduate Medical Education (UME) Section Chair, Southern Group on Educational Affairs (SGEA); Chair of Early Career Physicians, American College of Physicians (ACP), Virginia Chapter
DisclosuresConsultant/Advisory BoardNEJM Healer Advisory Group; Aquifer Clinical Excellence; NBME Clinical Reasoning
Grant/Research SupportSouthern Group on Educational Affairs (SGEA)
Editorial BoardsDiagnosis
Leadership Positions in Professional SocietiesUndergraduate Medical Education (UME) Section Chair, Southern Group on Educational Affairs (SGEA); Chair of Early Career Physicians, American College of Physicians (ACP), Virginia Chapter