Systemic corticosteroid therapy may reduce mortality by approximately 3%, the need for mechanical ventilation by approximately 5%, and hospital stay by approximately 1 day for hospitalized adults with community-acquired pneumonia (CAP), according to a meta-analysis of randomized trials of systemic corticosteriods in hospitalized adults with CAP. Results also indicated:

• The case for corticosteroids is stronger with more severe pneumonia.

• Adjunctive corticosteroids increased frequency of hyperglycemia requiring treatment but did not increase frequency of gastrointestinal hemorrhage.

Citation: Siemieniuk RAC, Meade MO, Briel M, et al. Corticosteroid therapy for patients hospitalized with community-acquired pneumonia. Ann Intern Med. [Published online ahead of print August 11, 2015]. doi: 10.7326/M15-0715.

Commentary: This landmark meta-analysis strongly suggests a significant clinical benefit to the routine use of corticosteroids for the treatment of community-acquired pneumonia. Given the strength of effect, and the low incidence and severity of side effects, it will be interesting to see if adjunctive treatment of patients with community acquired pneumonia, and perhaps hospital-acquired pneumonia, become incorporated into standard guidelines. —Neil Skolnik, MD