Special thanks to Ben Kerrey and Todd Florin, two of my fellow attendings who brought this issue to my attention and helped compile information for the post.
In adults with community acquired pneumonia there has been mounting evidence that adjunctive treatment with corticosteroids improves outcomes. There are two meta analyses, PLoS One, and Annals of Internal Medicine and several RCTs. As the Infectious Diseases Society of America guideline for adults from 2007 is currently being revised this issue remains up for debate.
This obviously begs the question as to whether or not corticosteroids will be helpful in kids – specifically in measurable metrics such as length of illness, length of hospital stay or disease course. As is the case with many issues in pediatrics the evidence is lacking or underdeveloped. In two retrospective studies the evidence suggests that children admitted with community acquired pneumonia who are not wheezing and/or do not have asthma will have higher rates of treatment failure and longer length of stay. See Ambroggio et al, from J Pediatric Infect Dis Soc, 2015 and Weiss et al, from Pediatrics, 2015 for more. Certainly though, children that have asthma and now have an exacerbation secondary (presumably) to their community acquired pneumonia will probably benefit from systemic corticosteroids. The 2010 IDSA community acquired pneumonia guidelines for children make no mention of this though.
The Bottom Line
- If a child under 18 years has community acquired pneumonia and DOES NOT have asthma there is currently insufficient evidence that corticosteroids will be beneficial.
- If a child under 18 has community acquired pneumonia and does have an asthma exacerbation as well (needing regular beta agonist treatments) then by all means give them steroids. And remember, dexamethasone is just as good as prednisone.
- If you have an adult patient with community acquired pneumonia, especially severe disease steroids might help.