Prednisolone not benficial in most cases of community-acquired pneumonia

Feb 23, 2010

Patients hospitalized with mild to moderate community-acquired pneumonia (CAP) should not be routinely prescribed prednisolone, a corticosteroid, as it is associated with a recurrence of symptoms after its withdrawal, according to the first randomized double-blind clinical trial to address the subject.

"Prednisolone therapy next to antibiotic therapy in patients hospitalized with CAP should not be recommend due to lack of clincial benefit and a higher rate of late failures," said Dominic Snijders, M.D., lead author on the study and at the Medical Centre Alkmaar in the Netherlands.

The findings have been published online ahead of print publication in the American Thoracic Society's .

To assess the efficacy of prednisolone therapy along with standard doctor-managed care for patients admitted to the hospital with CAP, Dr. Snijders and colleagues prospectively enrolled 213 patients who had been hospitalized with CAP and randomly assigned them to receive the usual as prescribed by their physicians supplemented with either prednisolone (40 mg dose once daily) or placebo for a week.

They found that patients on prednisolone recovered more rapidly from their fevers and had a more rapid decline in their c-reactive protein (CRP) levels than patients on placebo, indicating decreased inflammation. However, after 14 days, the patients in the prednisolone group had higher levels of CRP than the patients in the placebo group. Furthermore, three times as many patients in the prednisolone group had "late failure," defined as the recurrence of symptoms more than 72 hours after initial therapeutic success, and these patients were almost four times as likely to require additional than patients with late failure in the placebo group (6.7 percent versus 1.8 percent).

"Our study clearly shows that prednisolone therapy does not have a place in patients with CAP," said Dr. Snijders. However, he pointed out, in some cases such as when CAP is severe or occurs in conjunction with COPD, there is not enough information to draw a conclusion. Previous studies have found benefit of corticosteroid therapy among patients with severe CAP. Studies with patients with CAP and COPD have also indicated the possibility of a protective effect of prednisolone, but there have been no controlled trials.

Dr. Snijders suggested that the association of prednisolone therapy in CAP with late failures may be due to a rebound effect that could be precipitated by the abrupt withdrawal of the therapy. "Non-survivors on therapy died later than non-survivors without corticosteroids, respectively 13.8 versus 7.1 days," he wrote. "A tapering of the corticosteroids might protect against the rebound of inflammation."

"Further trials are indeed needed in patients with severe CAP," said Dr. Snijders. "Also, more information is needed about COPD patients, corticosteroids and pneumonia. Possible future intervention could be monoclonal TNF-alpha-antibodies or specific antibodies against other key mediators in the inflammation response. We are considering further studies in these directions."

Explore further: Obama addresses West Africans on facts about Ebola

add to favorites email to friend print save as pdf

Related Stories

COPD patients often given wrong treatment

Apr 21, 2009

(PhysOrg.com) -- Generally speaking, patients with COPD (Chronic Obstructive Pulmonary Disease) deteriorate suddenly, in bursts, often as a result of bacterial or viral infections.

Recommended for you

Obama addresses West Africans on facts about Ebola

2 hours ago

President Barack Obama urged West Africans on Tuesday to wear gloves and masks when caring for Ebola patients or burying anyone who died of the disease. He also discouraged the traditional burial practice ...

Gluten-free diet benefits asymptomatic EmA+ adults

2 hours ago

(HealthDay)—Asymptomatic individuals with endomysial antibodies (EmA) benefit from a gluten-free diet (GFD), according to a study published in the September issue of Gastroenterology.

Another US health worker infected with Ebola

3 hours ago

A third American health worker has tested positive for the Ebola virus while working with patients in West Africa, the Christian missionary group SIM said Tuesday.

UN implores all countries to help on Ebola

5 hours ago

The international group Doctor Without Borders warned Tuesday that the world is 'losing the battle' against Ebola, while U.N. officials implored all countries to quickly step up their response by contributing health experts ...

Travel restrictions could worsen Ebola crisis: experts

9 hours ago

Travel restrictions could worsen West Africa's Ebola epidemic, limiting medical and food supplies and keeping out much-needed doctors, virologists said Tuesday as the disease continued its deadly spread.

User comments : 0