title: New aspects in the management of pneumonia.
abstract: Despite improvements in the management of community-acquired pneumonia (CAP), morbidity and mortality are still high, especially in patients with more severe disease. Early and appropriate antibiotics remain the cornerstone in the treatment of CAP. However, two aspects seem to contribute to a worse outcome: an uncontrolled inflammatory reaction and an inadequate immune response. Adjuvant treatments, such as corticosteroids and intravenous immunoglobulins, have been proposed to counterbalance these effects. The use of corticosteroids in patients with severe CAP and a strong inflammatory reaction can reduce the time to clinical stability, the risk of treatment failure, and the risk of progression to acute respiratory distress syndrome. The administration of intravenous immunoglobulins seems to reinforce the immune response to the infection in particular in patients with inadequate levels of antibodies and when an enriched IgM preparation has been used; however, more studies are needed to determinate their impact on outcome and to define the population that will receive more benefit.
authors.affiliation: Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Prina
authors.affiliation: Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.|Seccion Neumologia, Hospital Nacional Alejandro Posadas, Palomar, Argentina.
authors.forename: Adrian
authors.initials: A
authors.lastname: Ceccato
authors.affiliation: Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain. ATORRES@clinic.ub.es.|Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Barcelona, Spain. ATORRES@clinic.ub.es.|UVIR, Servei de Pneumologia, Hospital Clínic, Villarroel 170., 08036, Barcelona, Spain. ATORRES@clinic.ub.es.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D003428:Cross Infection / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007113:Immunity, Innate / Q000502:physiology; D007136:Immunoglobulins / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D016753:Interleukin-10 / Q000032:analysis / Q000378:metabolism; D015850:Interleukin-6 / Q000032:analysis / Q000378:metabolism; D016209:Interleukin-8 / Q000032:analysis / Q000378:metabolism; D011014:Pneumonia / Q000188:drug therapy* / Q000378:metabolism*; D012196:Review Literature as Topic; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications / Q000188:drug therapy / Q000209:etiology
chemical_list: D000305:Adrenal Cortex Hormones; C508609:IL10 protein, human; C508600:IL6 protein, human; D007136:Immunoglobulins; D015850:Interleukin-6; D016209:Interleukin-8; D016753:Interleukin-10
keywords: Community-acquired pneumonia; Corticosteroid; Immunoglobulin