Treatment with prednisolone may lead to the recurrence of symptoms in patients admitted to hospital with community-acquired pneumonia (CAP), researchers have found.
Their findings, published online in the American Journal of Respiratory and Critical Care Medicine (4 February 2010) suggest that corticosteroids should not be used routinely for the community-acquired form of the illness.
Over 200 Dutch patients with CAP were given either 40mg prednisolone for seven days or placebo, alongside antibiotics. Three times as many patients on prednisolone than on placebo had recurrence of symptoms more than three days after being admitted (19.2 per cent compared with 6.4 per cent).
The authors conclude: “Because of its association with increased late failure in patients with non-severe CAP and lack of benefit prednisolone should not be recommended as routine adjunct treatment in CAP.”
“A benefit in more severely ill patients cannot be excluded,” they say.
Study method and resultsIn this randomised controlled trial, 213 patients were assessed and disease severity was scored using CURB-65 (a rule for predicting mortality in CAP) and the Pneumonia Severity Index (PSI). Initially, 54 patients (25.4 per cent) had a CURB-65 >2 and 93 patients (43.7 per cent) were in Pneumonia Severity Index class IV-V. Clinical cure at days 7 and 30 was 80.8 per cent and 66.3 per cent, respectively, in the prednisolone group (n=104), and 85.3 per cent and 77.1 per cent, respectively, in the placebo group (n=109; P=0.38 and P=0.08). In total, 20 patients had late failure (a recurrence of signs and symptoms of pneumonia after 72 hours of admission following an initially beneficial response to treatment) in the prednisolone group compared with 10 patients in the placebo group (P=0.04). |
