title: Efficacy of corticosteroids in the treatment of community-acquired pneumonia requiring hospitalization.
abstract: 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.
authors: Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
authors: Katsunaka
authors: K
authors: Mikami
authors: Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan. m-suzuki@kanto-ctr-hsp.com.
authors: Masaru
authors: M
authors: Suzuki
authors: Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
authors: Hiroshi
authors: H
authors: Kitagawa
authors: Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
authors: Masaki
authors: M
authors: Kawakami
authors: Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
authors: Nobuaki
authors: N
authors: Hirota
authors: Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
authors: Hiromichi
authors: H
authors: Yamaguchi
authors: Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
authors: Osamu
authors: O
authors: Narumoto
authors: Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
authors: Yoshiko
authors: Y
authors: Kichikawa
authors: Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
authors: Makoto
authors: M
authors: Kawai
authors: Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
authors: Hiroyuki
authors: H
authors: Tashimo
authors: Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
authors: Hidenori
authors: H
authors: Arai
authors: Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
authors: Tadashi
authors: T
authors: Horiuchi
authors: Department of Internal Medicine, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, 158-8531, Tokyo, Japan.
authors: Yoshio
authors: Y
authors: Sakamoto
mesh_terms: 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
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D011239:Prednisolone
references: N Engl J Med. 2002 Nov 14;347(20):1549-56
references: 12432041
references: N Engl J Med. 2003 Feb 20;348(8):727-34
references: 12594318
references: JAMA. 1997 Dec 17;278(23):2080-4
references: 9403422
references: Am J Respir Crit Care Med. 2001 Jun;163(7):1730-54
references: 11401897
references: Eur Respir J. 1998 Mar;11(3):534-41
references: 9596098
references: Clin Infect Dis. 2004 Sep 1;39 Suppl 3:S159-64
references: 15546111
references: Am J Respir Crit Care Med. 1998 Jun;157(6 Pt 1):1721-5
references: 9620897
references: Chest. 1995 May;107(5):1342-9
references: 7750329
references: Am Rev Respir Dis. 1990 Feb;141(2):471-501
references: 2405761
references: Rev Infect Dis. 1989 Nov-Dec;11(6):954-63
references: 2690289
references: Intensive Care Med. 2006 Apr;32(4):595-8
references: 16552616
references: Arch Intern Med. 2001 Mar 26;161(6):848-50
references: 11268227
references: N Engl J Med. 1988 Oct 13;319(15):964-71
references: 3047581
references: Pulm Pharmacol Ther. 2002;15(4):353-5
references: 12220939
references: Clin Infect Dis. 2003 Sep 15;37(6):761-3
references: 12955635
references: N Engl J Med. 1997 Jan 23;336(4):243-50
references: 8995086
references: Crit Care Med. 1999 Apr;27(4):723-32
references: 10321661
references: N Engl J Med. 1999 Jun 24;340(25):1941-7
references: 10379017
references: Ann Intern Med. 2001 Apr 3;134(7):600-20
references: 11281745
references: Arch Intern Med. 1999 Nov 22;159(21):2576-80
references: 10573047
references: Am J Respir Crit Care Med. 1994 Sep;150(3):710-6
references: 8087341
references: JAMA. 2002 Aug 21;288(7):862-71
references: 12186604
references: Eur Respir J. 1999 Jul;14(1):218-20
references: 10489855
references: Arch Intern Med. 1999 Nov 22;159(21):2562-72
references: 10573046
references: Am J Respir Crit Care Med. 2005 Feb 1;171(3):242-8
references: 15557131
references: N Engl J Med. 1995 Dec 14;333(24):1618-24
references: 7477199
references: Chest. 2002 Nov;122(5):1784-96
references: 12426284