Intervention Review

Corticosteroids for pneumonia

  1. Yuanjing Chen2,
  2. Ka Li3,
  3. Hongshan Pu4,
  4. Taixiang Wu1,*

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 16 MAR 2011

Assessed as up-to-date: 30 DEC 2010

DOI: 10.1002/14651858.CD007720.pub2

Database Title

Additional Information

How to Cite

Chen Y, Li K, Pu H, Wu T. Corticosteroids for pneumonia. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD007720. DOI: 10.1002/14651858.CD007720.pub2.

Author Information

  1. 1

    West China Hospital, Sichuan University, Chinese Cochrane Centre, Chinese Clinical Trial Registry, Chinese Evidence-Based Medicine Centre, INCLEN Resource and Training Centre, Chengdu, Sichuan, China

  2. 2

    West China Hospital, Sichuan University, Department of Anesthesiology, Chengdu, Sichuan, China

  3. 3

    West China Hospital, Sichuan University, Department of Surgery III, Chengdu, Sichuan, China

  4. 4

    West China Hospital, Sichuan University, Chengdu, Sichuan, China

*Taixiang Wu, Chinese Cochrane Centre, Chinese Clinical Trial Registry, Chinese Evidence-Based Medicine Centre, INCLEN Resource and Training Centre, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, China. txwutx@hotmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 16 MAR 2011

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Background

Pneumonia is an acute inflammation of the lungs and treatments differ depending on the type and severity. Corticosteroids can influence immune regulation, carbohydrate metabolism, protein catabolism, electrolyte balance and stress response. However, the benefits of corticosteroids for patients with pneumonia remains unclear.

Objectives

To assess the efficacy and safety of corticosteroids in the treatment of pneumonia.

Search methods

We searched Cochrane Central Register of Controlled Clinical Trials (CENTRAL) (The Cochrane Library 2010, Issue 11) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to December week 4, 2010), EMBASE (1974 to December 2010), the China National Knowledge Infrastructure (CNKI) (1978 to December 2010) and VIP (1986 to December 2010).

Selection criteria

Randomised controlled trials (RCTs) assessing the effectiveness of corticosteroids for pneumonia.

Data collection and analysis

Three review authors selected studies. We telephoned the trial authors to confirm the randomisation method used. We extracted and analysed the methodological details and data from the included studies.

Main results

We included six studies including 437 participants in the review. Two studies were of high methodological quality and three were of poor quality. All studies involved small numbers of participants. Two small studies provided weak evidence that corticosteroids did not significantly reduce mortality (Peto odds ratio (OR) 0.26; 95% CI 0.05 to 1.37), but accelerated the resolution of symptoms or time to clinical stability, and decreased the rate of relapse of the disease. Steroids can improve the oxygenation and reduce the need for mechanical ventilation in severe pneumonia. There was no significant difference between treatment groups with regards to the time to discharge from the intensive care unit (ICU). There were insufficient data to report the time to pneumonia resolution and admission to ICU. Typical adverse events associated with corticosteroid therapy were infrequent.

Authors' conclusions

In most patients with pneumonia, corticosteroids are generally beneficial for accelerating the time to resolution of symptoms. However, evidence from the included studies was not strong enough to make any recommendations.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Corticosteroids for pneumonia

Pneumonia is an acute respiratory disease that is usually caused by bacteria but it can also be caused by other infectious agents such as fungi, parasites and viruses. Corticosteroids can act as an anti-inflammatory agent for patients with pneumonia but they can adversely suppress the immune system, which prevents the body from fighting the causative pathogens and results in a serious infection. The purpose of this review was to assess whether corticosteroids for pneumonia are beneficial.

We identified six trials (437 participants) and found that although the effects of corticosteroids vary depending on the type and severity of pneumonia, the overall effect is beneficial for most patients. Corticosteroids did not significantly reduce mortality compared to the placebo group. Arrhythmia, upper gastrointestinal bleeding and malignant hypertension may be related to corticosteroids. The evidence from this review is weak due to limitations of the included studies. Large trials with more patients are needed to provide robust evidence.

 

Resumen

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Antecedentes

Corticosteroides para la neumonía

La neumonía es una inflamación aguda del pulmón, y los tratamientos difieren según el tipo y la gravedad. Los corticosteroides pueden influir en la regulación inmunitaria, el metabolismo de los carbohidratos, el catabolismo proteico, el balance electrolítico y la respuesta al estrés. Sin embargo, aún no pueden precisarse los beneficios de los corticosteroides para los pacientes con neumonía.

Objetivos

Evaluar la eficacia y la seguridad de los corticosteroides en el tratamiento de la neumonía.

Estrategia de búsqueda

Se hicieron búsquedas en el Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Clinical Trials) (CENTRAL) (The Cochrane Library, Número 11, 2010) que contiene el registro especializado del Grupo Cochrane de Infecciones Respiratorias Agudas (Cochrane Acute Respiratory Infections Group), MEDLINE (1966 hasta diciembre, semana 4, 2010), EMBASE (1974 hasta diciembre 2010), the China National Knowledge Infrastructure (CNKI) (1978 hasta diciembre 2010) y en VIP (1986 hasta diciembre 2010).

Criterios de selección

Ensayos controlados aleatorios (ECA) que evaluaran la efectividad de los corticosteroides para la neumonía.

Obtención y análisis de los datos

Tres autores de la revisión seleccionaron los estudios. Se contactó por teléfono a los autores de los ensayos para confirmar el método de asignación al azar utilizado. Se extrajeron y analizaron los detalles metodológicos y los datos de los estudios incluidos.

Resultados principales

Se incluyeron seis estudios con 437 participantes en la revisión. Dos estudios eran de calidad metodológica alta y tres eran de calidad deficiente. Todos los estudios implicaron a un reducido número de participantes. Dos estudios pequeños proporcionaron pruebas débiles de que los corticosteroides no redujeron significativamente la mortalidad (odds ratio [OR] de Peto 0,26; IC del 95%: 0,05 a 1,37), pero aceleraron la resolución de los síntomas o el tiempo hasta la estabilidad clínica, y disminuyeron la tasa de recaída de la enfermedad. Los esteroides pueden mejorar la oxigenación y reducir la necesidad de asistencia respiratoria mecánica en la neumonía grave. No hubo diferencias significativas entre los grupos de tratamiento con respecto al tiempo hasta el alta de la unidad de cuidados intensivos (UCI). No hubo datos suficientes para informar el tiempo hasta la resolución de la neumonía y el ingreso a la UCI. Los eventos adversos típicos asociados con el tratamiento con corticosteroides fueron poco frecuentes.

Conclusiones de los autores

Por lo general, en la mayoría de los pacientes con neumonía, los corticosteroides son beneficiosos para la aceleración del tiempo hasta la resolución de los síntomas. Sin embargo, las pruebas de los estudios incluidos no fueron lo suficientemente sólidas como para establecer recomendaciones.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano

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