An overview of the recent trials of corticosteroids for severe community-acquired pneumonia

The use of corticosteroids in the setting of community-acquired pneumonia (CAP) remains controversial. Here we review the evidence for and against corticosteroids in the setting of CAP with a particular focus on three recent randomized, placebo-controlled trials that have disparate results but significantly advance our knowledge in the field. Current published data does not support widespread use of corticosteroids in CAP with evidence this is more likely to cause harm than benefit. The use of hydrocortisone in a limited number of patients with respiratory failure of less than 24 hours duration and a serum c-reactive protein >200 mg/L may be supportable if a high dependency setting is available to address hyperglycemia. Disparate results and polarized positions amongst experts in the field will only be resolved by studies with tighter entry criteria, better definition of target groups, consideration of the infecting pathogen and therapeutic window for benefit.