Controversy surrounds the use of adjunctive
corticosteroids in severe community acquired
pneumonia (CAP) as current guidelines either do not address or discourage their use. Double-blind, placebo-controlled, randomized controlled trials examining systemic
corticosteroids in the treatment of severe CAP were summarized and their impacts on patient-important outcomes assessed. Four trials describing systemic
corticosteroid use in adults with severe CAP were identified. One trial had a significant mortality difference favoring
corticosteroids. However, this may be the result of a CAP severity imbalance within the trial and the mortality benefit was not confirmed in a larger trial conducted in a similar
critical care setting.
Pneumonia severity, mortality assessment timing, comorbidities,
corticosteroid and
antibiotic choice and timing in the
CAP disease course, and bias risks varied across the four trials. Because of the clinical heterogeneity of available studies and the unknowns pertaining to clinical efficacy and safety, we do not recommend the use of adjunctive
corticosteroids in severe CAP.