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Treatment of Pneumonia

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Background: Pneumonia is the leading infectious cause of death in the United States.1 The microorganism most commonly responsible for community-acquired pneumonia (CAP) is S. pneumoniae. Current treatment focuses on eradicating the causative microorganism with antimicrobial therapy.2 Severe CAP often leads to complications such as sepsis and organ failure, such that many patients require mechanical ventilation and admission to the intensive care unit.1

Corticosteroids are currently FDA approved and indicated for the treatment and prophylaxis of asthma.3 The bronchial anti-inflammatory action is achieved through direct inhibition of the mediating cells, including macrophages, T-lymphocytes, and eosinophils. An additional benefit is reduced mucus secretion in airways. These actions spark the question of whether or not there may be a use for corticosteroids in the treatment of CAP. Current American Thoracic Society guidelines recommend corticosteroids only in patients with proven low cortisol levels.4 Interest in systemic corticosteroids has led to studies seeking a possible benefit in reducing mortality in CAP patients.5,6

Literature search strategy: A search was conducted using MEDLINE® via Ovid (1946 to February Week 3 2012). Medical subject headings (MeSH) used included: pneumonia, community-acquired infections, adrenal cortex hormones, and glucocorticoids. Drug therapy and therapy were the subheadings used for pneumonia. Therapy was used as a subcategory for adrenal cortex hormones along with therapeutic use, which was also used for and glucocorticoids. Pneumonia was linked to community-acquired infections with AND while OR was used to link adrenal cortex hormones to glucocorticoids. These searches were combined with AND th...

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...Society of America/American Thoracic Society consensus guidelines on the management of community-aquired pneumonia in adults. Clin Infect Dis. 2007;44(suppl 2):s27-s72. http://cid.oxfordjournals.org/citmgr?gca=cid;44/Supplement_2/S27. Accessed February 24, 2012.

5. Salluh JI, Soares M, Coelho LM, et al. Impact of systemic corticosteroids on the clinical course and outcomes of patients with severe community-acquired pneumonia: a cohort study. J Crit Care. 2011;26(2):193-200. http://www.sciencedirect.com. ezproxy.mcphs.edu/science/article/pii/S0883944110001929. Accessed February 23, 2012.

6. Garcia-Vidal C, Calbo E, Pascual V, Ferrer C, Quintana S, Garau J. Effects of systemic steroids in patients with severe community-acquired pneumonia. Eur Respir J. 2007;30(5):951-6. http://erj.ersjournals.com/content/30/5/951.full. Accessed February 23, 2012.