title: Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial.
abstract: BACKGROUND
  Whether addition of corticosteroids to antibiotic treatment benefits patients with community-acquired pneumonia who are not in intensive care units is unclear. We aimed to assess effect of addition of dexamethasone on length of stay in this group, which might result in earlier resolution of pneumonia through dampening of systemic inflammation.
  
  
  METHODS
  In our double-blind, placebo-controlled trial, we randomly assigned adults aged 18 years or older with confirmed community-acquired pneumonia who presented to emergency departments of two teaching hospitals in the Netherlands to receive intravenous dexamethasone (5 mg once a day) or placebo for 4 days from admission. Patients were ineligible if they were immunocompromised, needed immediate transfer to an intensive-care unit, or were already receiving corticosteroids or immunosuppressive drugs. We randomly allocated patients on a one-to-one basis to treatment groups with a computerised randomisation allocation sequence in blocks of 20. The primary outcome was length of hospital stay in all enrolled patients. This study is registered with ClinicalTrials.gov, number NCT00471640.
  
  
  RESULTS
  Between November, 2007, and September, 2010, we enrolled 304 patients and randomly allocated 153 to the placebo group and 151 to the dexamethasone group. 143 (47%) of 304 enrolled patients had pneumonia of pneumonia severity index class 4-5 (79 [52%] patients in the dexamethasone group and 64 [42%] controls). Median length of stay was 6·5 days (IQR 5·0-9·0) in the dexamethasone group compared with 7·5 days (5·3-11·5) in the placebo group (95% CI of difference in medians 0-2 days; p=0·0480). In-hospital mortality and severe adverse events were infrequent and rates did not differ between groups, although 67 (44%) of 151 patients in the dexamethasone group had hyperglycaemia compared with 35 (23%) of 153 controls (p<0·0001).
  
  
  CONCLUSIONS
  Dexamethasone can reduce length of hospital stay when added to antibiotic treatment in non-immunocompromised patients with community-acquired pneumonia.
  
  
  BACKGROUND
  None.
authors.affiliation: Department of Internal Medicine, St Antonius Hospital, Nieuwegein, Netherlands. s.meijvis@antoniusziekenhuis.nl
authors.forename: Sabine C A
authors.initials: SC
authors.lastname: Meijvis
authors.forename: Hans
authors.initials: H
authors.lastname: Hardeman
authors.forename: Hilde H F
authors.initials: HH
authors.lastname: Remmelts
authors.forename: Rik
authors.initials: R
authors.lastname: Heijligenberg
authors.forename: Ger T
authors.initials: GT
authors.lastname: Rijkers
authors.forename: Heleen
authors.initials: H
authors.lastname: van Velzen-Blad
authors.forename: G Paul
authors.initials: GP
authors.lastname: Voorn
authors.forename: Ewoudt M W
authors.initials: EM
authors.lastname: van de Garde
authors.forename: Henrik
authors.initials: H
authors.lastname: Endeman
authors.forename: Jan C
authors.initials: JC
authors.lastname: Grutters
authors.forename: Willem Jan W
authors.initials: WJ
authors.lastname: Bos
authors.forename: Douwe H
authors.initials: DH
authors.lastname: Biesma
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007275:Injections, Intravenous; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D003907:Dexamethasone