Journal Jam 17 – Steroids for CAP and COVID Pneumonia

When I asked about a dozen ED docs, internists, ID specialists and intensivists whether or not they used steroids for community acquired pneumonia, I did not receive one definitive clear answer. But when I asked them whether or not they would use steroids for COVID pneumonia, they all clearly and definitively said a resounding “yes” (and most of them added that it was the only drug besides oxygen that was effective for COVID pneumonia). So this got me thinking - what are the indications for steroids in patients with pneumonia besides those with concurrent COPD exacerbations, ARDS or adrenal shock? This is Journal Jam - so, the other question is: what is the evidence for benefit for steroids in CAP, the flu and COVID pneumonia? And if there is benefit, do those benefits outweigh the potential harms? To help us sort this out, Justin and Anton have the mighty return of a special guest - Dr. Andrew Morris in this Journal Jam podcast... Steroids are thought to curb the inflammatory response in CAP, improve symptoms, reduce the frequency of acute respiratory distress syndrome, and decrease the length of illness. Articles discussed in this Journal Jam podcast on steroids and pneumonia Community Acquired Pneumonia (CAP) Stern A, Skalsky  K, Avni  T, Carrara  E, Leibovici  L, Paul  M. Corticosteroids for pneumonia. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD007720. Confalonieri M, Urbino R, Potena A, Piattella M, Parigi P, Puccio G, Della Porta R, Giorgio C, Blasi F, Umberger R, Meduri GU. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med. 2005 Feb 1;171(3):242-8. Meijvis SC, Hardeman H, Remmelts HH, Heijligenberg R, Rijkers GT, van Velzen-Blad H, Voorn GP, van de Garde EM, Endeman H, Grutters JC, Bos WJ, Biesma DH. Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial. Lancet. 2011 Jun 11;377(9782):2023-30. doi: 10.1016/S0140-6736(11)60607-7. Epub 2011 Jun 1. PMID: 21636122. Nafae, R. M. et al. Adjuvant role of corticosteroids in the treatment of community-acquired pneumonia. Egyptian Journal of Chest Diseases and Tuberculosis. 62(3), 7-2013, 439-445. Torres A, Sibila O, Ferrer M, et al. Effect of Corticosteroids on Treatment Failure Among Hospitalized Patients With Severe Community-Acquired Pneumonia and High Inflammatory Response: A Randomized Clinical Trial. JAMA. 2015;313(7):677–686. Blum CA, Nigro N, Briel M, Schuetz P, Ullmer E, Suter-Widmer I, Winzeler B, Bingisser R, Elsaesser H, Drozdov D, Arici B, Urwyler SA, Refardt J, Tarr P, Wirz S, Thomann R, Baumgartner C, Duplain H, Burki D, Zimmerli W, Rodondi N, Mueller B, Christ-Crain M. Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial. Lancet. 2015 Apr 18;385(9977):1511-8. Lloyd M, Karahalios A, Janus E, Skinner EH, Haines T, De Silva A, Lowe S, Shackell M, Ko S, Desmond L, Karunajeewa H; Improving Evidence-Based Treatment Gaps and Outcomes in Community-Acquired Pneumonia (IMPROVE-GAP) Implementation Team at Western Health. Effectiveness of a Bundled Intervention Including Adjunctive Corticosteroids on Outcomes of Hospitalized Patients With Community-Acquired Pneumonia: A Stepped-Wedge Randomized Clinical Trial. JAMA Intern Med. 2019 Jul 8;179(8):1052–60. Influenza Lansbury  L, Rodrigo  C, Leonardi‐Bee  J, Nguyen‐Van‐Tam  J, Lim  WS. Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD010406. COVID Pneumonia Angus DC, Derde L, Al-Beidh F, Annane D, Arabi Y, Beane A, et al. Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The R...