title: Effect of corticosteroids on the clinical course of community-acquired pneumonia: a randomized controlled trial.
abstract: BACKGROUND
  The benefit of corticosteroids as adjunctive treatment in patients with severe community-acquired pneumonia (CAP) requiring hospital admission remains unclear. This study aimed to evaluate the impact of corticosteroid treatment on outcomes in patients with CAP.
  
  
  METHODS
  This was a prospective, double-blind and randomized study. All patients received treatment with ceftriaxone plus levofloxacin and methyl-prednisolone (MPDN) administered randomly and blindly as an initial bolus, followed by a tapering regimen, or placebo.
  
  
  RESULTS
  Of the 56 patients included in the study, 28 (50%) were treated with concomitant corticosteroids. Patients included in the MPDN group show a more favourable evolution of the pO2/FiO2 ratio and faster decrease of fever, as well as greater radiological improvement at seven days. The time to resolution of morbidity was also significantly shorter in this group. Six patients met the criteria for mechanical ventilation (MV): five in the placebo group (22.7%) and one in the MPDN group (4.3%). The duration of MV was 13 days (interquartile range 7 to 26 days) for the placebo group and three days for the only case in the MPDN group. The differences did not reach statistical significance. Interleukin (IL)-6 and C-reactive protein (CRP) showed a significantly quicker decrease after 24 h of treatment among patients treated with MPDN. No differences in mortality were found among groups.
  
  
  CONCLUSIONS
  MPDN treatment, in combination with antibiotics, improves respiratory failure and accelerates the timing of clinical resolution of severe CAP needing hospital admission.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trials Register, ISRCTN22426306.
authors.affiliation: Respiratory Medicine Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Fernández-Serrano
authors.forename: Jordi
authors.initials: J
authors.lastname: Dorca
authors.forename: Carolina
authors.initials: C
authors.lastname: Garcia-Vidal
authors.forename: Núria
authors.initials: N
authors.lastname: Fernández-Sabé
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratalà
authors.forename: Ana
authors.initials: A
authors.lastname: Fernández-Agüera
authors.forename: Mercè
authors.initials: M
authors.lastname: Corominas
authors.forename: Susana
authors.initials: S
authors.lastname: Padrones
authors.forename: Francesc
authors.initials: F
authors.lastname: Gudiol
authors.forename: Frederic
authors.initials: F
authors.lastname: Manresa
mesh_terms: D000368:Aged; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007877:Legionnaires' Disease / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D008775:Methylprednisolone