Efficacy of corticosteroids in the treatment of community-acquired pneumonia requiring hospitalization.
BACKGROUND
Recent studies suggested that administration of corticosteroids may improve clinical outcomes in patients with severe pneumonia.


OBJECTIVE
The aim of this study was to assess the effectiveness of corticosteroids as an adjunctive therapy in community-acquired pneumonia (CAP) requiring hospitalization.


METHODS
An open label, prospective, randomized control study was conducted from September 2003 to February 2004 in a community general hospital in Japan.


METHODS
Thirty-one adult CAP patients who required hospitalization were enrolled.


RESULTS
Fifteen patients received 40 mg of prednisolone intravenously for 3 days (steroid group). Sixteen patients did not receive prednisolone (control group). Both groups were also evaluated for their adrenal function. The primary endpoint was length of hospital stay. Secondary endpoints were duration of intravenous (IV) antibiotics and time required to stabilize vital signs. Both groups demonstrated similar baseline characteristics and length of hospital stay, and yet a shorter duration of IV antibiotics was observed in the steroid group (p < 0.05). In addition, vital signs were stabilized earlier in the steroid group (p < 0.05). These differences were more prominent in the moderate-severe subgroup but not as significant in the mild-moderate subgroup. The prevalence of relative adrenal insufficiency (RAI) in both groups was high (43%), yet there was no difference in baseline characteristics between patients, with or without RAI. In multiple regression models, RAI seemed to have no influence on clinical courses.


CONCLUSIONS
In moderate-severe CAP, administration of corticosteroids promotes resolution of clinical symptoms and reduces the duration of intravenous antibiotic therapy.
Mikami
Katsunaka
K
Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
Suzuki
Masaru
M
Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan. m-suzuki@kanto-ctr-hsp.com.
Kitagawa
Hiroshi
H
Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
Kawakami
Masaki
M
Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
Hirota
Nobuaki
N
Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
Yamaguchi
Hiromichi
H
Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
Narumoto
Osamu
O
Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
Kichikawa
Yoshiko
Y
Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
Kawai
Makoto
M
Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
Tashimo
Hiroyuki
H
Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
Arai
Hidenori
H
Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
Horiuchi
Tadashi
T
Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
Sakamoto
Yoshio
Y
Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000309:Adrenal Insufficiency / Q000188:drug therapy / Q000382:microbiology*; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D004334:Drug Administration Schedule; D005260:Female; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010912:Pituitary-Adrenal Function Tests; D018410:Pneumonia, Bacterial / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D011239:Prednisolone
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