Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Metlay JP, Waterer GW, Long AC, et al ; Am J Respir Crit Care Med 2019;200(7):e45-67
Guideline-Based Clinical Assessment Versus Procalcitonin-Guided Antibiotic Use in Pneumonia: A Pragmatic Randomized Trial. Montassier E, Javaudin F, Moustafa F, Nandjou D, Maignan M, Hardouin JB, Annoot C, Ogielska M, Orer PL, Schotté T, Bouget J, Agha Babaei S, Raynal PA, Eche A, Duc AT, Cojocaru RA, Benaouicha N, Potel G, Batard E, Talan DA. Ann Emerg Med. 2019 Apr 11. pii: S0196-0644(19)30147-7. doi: 10.1016/j.annemergmed.2019.02.025. [Epub ahead of print]
CONCLUSION: Guideline-based serial clinical assessment did not reduce antibiotic exposure compared with procalcitonin-guided care among ED patients with community-acquired pneumonia. The strategies were similar in terms of duration of antibiotic use and clinical outcomes.
CONCLUSIONS:The best evidence supports CRP as the preferred biomarker for diagnosis of outpatient CAP given its accuracy, low cost, and point-of-care availability.
Effectiveness of a Bundled Intervention Including Adjunctive Corticosteroids on Outcomes of Hospitalized Patients With Community-Acquired Pneumonia: A Stepped-Wedge Randomized Clinical Trial. Lloyd M, Karahalios A, Janus E, Skinner EH, Haines T, De Silva A, Lowe S, Shackell M, Ko S, Desmond L, Karunajeewa H; Improving Evidence-Based Treatment Gaps and Outcomes in Community-Acquired Pneumonia (IMPROVE-GAP) Implementation Team at Western Health. JAMA Intern Med. 2019 Jul 8. doi: 10.1001/jamainternmed.2019.1438. [Epub ahead of print]
Are Corticosteroids Beneficial in the Treatment of Community-Acquired Pneumonia? Seagraves T, Gottlieb M. Ann Emerg Med. 2019 Jul;74(1):e1-e3. doi: 10.1016/j.annemergmed.2018.05.001. Epub 2018 Jun 22. No abstract available. PMID: 29937237
Efficacy of corticosteroid treatment for severe community-acquired pneumonia: A meta-analysis. Wu WF, Fang Q, He GJ, Am J Emerg Med. 2018 Feb;36(2):179-184. doi: 10.1016/j.ajem.2017.07.050. Epub 2017 Jul 15. PubMed PMID: 28756034.
Are Corticosteroids Beneficial in the Treatment of Community-Acquired Pneumonia? Seagraves, Thomas et al. Annals of Emergency Medicine, Published online, June 21, 2018, DOI: https://doi.org/10.1016/j.annemergmed.2018.05.001
Take-Home Message: For adult patients with severe community-acquired pneumonia, corticosteroids reduce morbidity and mortality. For pediatric patients and adults with nonsevere community-acquired pneumonia, corticosteroids appear to reduce morbidity, but not mortality.
The average duration of treatment was 7 days. Most adult studies used a corticosteroid dose equivalent to 40 to 50 mg of prednisone per day.