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Patients with severe pneumonia who are in the ICU have a mortality rate of as high as 20%. Therapies to reduce this mortality rate are needed and one potential adjunct, corticosteroids, are reviewed in this paper.
Sean G., M.D. - July 2, 2015 12:02 PM
This article is terrible. yet another useless waste of paper. Why are so many people trying to find a role for corticosteroids? When u think about it, the postulate is a bit twisted....We will block the body's natural response to injury/insult and this will be good. #1 I know in certain circumstances they are good, RAD meningitis for two. but #2 generally a normal human being was built to survive infections and injuries...why in the name of God are so many doctors convinced they are smarter then the body's natural healing process? I would be willing to bet on a whole corticosteroids have done more harm to humans then good. It would be very hard to prove but my gut tells me its true. In certain circumstances COPD asthma its a necessary evil today, but its a reactive treatment generally, we would be much better off if we could "fix" the cause of these diseases rather then band aid them...but then again Big Pharma would not be so rich if we cured things so that aint gonna happen, not in our great grand kids life time.
Jeff H., M.D. - July 15, 2015 11:27 AM
I'm not ready to throw out steroids for all infections (including pneumonia). Check out this article below along with nearly a dozen similar research publications (studying steroids for various infections) over the last few years. Certainly there is no mortality benefit. But on the other hand, there is very little harm demonstrated. I think if I had severe pneumonia (hospitalized or not) then I'd seriously consider a course of steroids. The outcomes that I'd still care about are not studied such as time to return to work, exercise capacity 1 month post discharge...
Lancet 2015; 385: 1511–18
Sean G., M.D. - July 20, 2015 5:41 AM
Problem is many potential complications are unknown...in the words of that Great 21st Century mind Donald Rumsfeld....there are known knowns and known unknowns but its the unknown unknowns that....ahhhh u get the picture. what I am saying is how many people would think Cipro could lead to tendon rupture? I mean its an antibiotic right? It kills bacteria why would it damage human tendons(I realize there are many smart people that probably think that is an idiotic statement, but remember there are also people like me, and well....rumsfeld out there. Seriously what I am saying is just because we dont have direct evidence of potential harm of occassional courses of steroids I certainly think we can all agree they are powerful drugs(put my mastiff on 100 mg a day of pred cause I thought she had Masticatory Myositis since it seemed her only sign of illness was dramatic wasting of the muscles of mastication. Pretty much killed her because several days later the real cause of her facial wasting was revealed, Coccidiodomycosis....it was just an odd presentation with no fever, weight loss or anorexia just wasting of her facial muscles till my clever suppression of her immune system allowed the fungus to go hog wild and she developed absesses and boney lesions and was dead 2 weeks later despite 10g's in ICU care and pretty much 24/7 nursing from my wife and I. My point is they are powerful drugs no doubt and the short and long term effect of them in sick pts is not so clearly seen despite research. Sometimes you need to use your gut in medicine, and for me, we in the West rely far too much on pils....just look at your local deaths due to Rx opioid abuse if your not sure on that one. Lot of the Chinese dying from Oxy's...don't think so. Just not so hot on the "give em drugs" band wagon.
Jeff H., M.D. - July 30, 2015 12:55 PM
I think the studies have quite clearly shown there is no significant harm from short courses of steroids treating a number of illnesses (pneumonia, purulent pharyngitis, asthma and COPD). I agree that the evidence showing benefit is weak and there is certainly no mortality benefit. But many physicians are treating strep throat with pulse dose steroids so the patient may recover marginally faster (24-48hrs), so my opinion to not give up on this treatment is not way out there.
I always apply the thought process, "what would I want if I were the patient" when these controversal treatments are considered. If I were off work feeling like crap with pneumonia and a pulse course of steroids could get me back to work a day sooner, I would take it (especially since no harm seems to be answered). So I'm holding out to see if there might be a minor role for steroids to play in treating pneumonia and other illnesses with significant morbidity.