A recent meta-analysis and systematic review of 13 randomized, placebo-controlled trials analyzed over 2000 patients hospitalized for CAP. The analysis examined whether the addition of systemic corticosteroids doses (20–60 mg of prednisone or steroid equivalent) to empiric antibiotics was any better than antibiotics alone. The analysis found a significantly lower incidences of in-hospital mortality (5.3% vs. 7.9%, NNT 38), acute respiratory distress syndrome (0.4% vs. 3.0%; NNT 38), mechanical ventilation (3.1% vs. 5.7%; NNT, 38) and shortened hospital length of stay (by 1.0 days) for addition of steroids vs placebo. The mortality benefit was only in the group with severe pneumonia (7.4% vs. 22.0%; NNT, 7).
This provides preliminary data to support the addition of moderate-dose corticosteroids for patients admitted to the hospital with moderate-to-severe CAP (especially if they are admitted to the ICU and require mechanical ventilation). Further studies are needed to validate this meta-analysis.