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The role of steroids in pneumonia is controversial. Steroids were found to reduce mortality in COVID-19 patients requiring at least supplemental oxygen but are not associated with a mortality benefit in influenza. In 2019, the Infectious Disease Society of America recommended against the routine use of steroids in hospitalized patients with community-acquired pneumonia (CAP) while the Society for Critical Care Medicine recommends steroids in these patients. Studies of steroids in pneumonia continue to have mixed results (e.g. ESCAPe found no benefit in their trial of a continuous infusion of methylprednisolone in severely ill patients with CAP). In this podcast episode, we review a new multicenter randomized trial of hydrocortisone in severe CAP.

References:

1. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
2. Pastores SM, Annane D, Rochwerg B; Corticosteroid Guideline Task Force of SCCM and ESICM. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Med. 2018 Apr;44(4):474-477. doi: 10.1007/s00134-017-4951-5. Epub 2017 Oct 31. PMID: 29090327.
3. Stern A, Skalsky K, Avni T, Carrara E, Leibovici L, Paul M. Corticosteroids for pneumonia. Cochrane Database Syst Rev. 2017 Dec 13;12(12):CD007720. doi: 10.1002/14651858.CD007720.pub3. PMID: 29236286; PMCID: PMC6486210.