Corticosteroids for Pneumonia Treatment 2024 PDF

12/3/24, 7:38 PM Corticosteroids for Pneumonia in Patients Admitted to General Medicine Units SUMMARY AND COMMENT | GENERAL MEDICINE, HOSPITAL MEDICINE INFORMING PRACTICE December 3, 2024 Corticosteroids for Pneumonia in Patients Admitted to Ge...

12/3/24, 7:38 PM Corticosteroids for Pneumonia in Patients Admitted to General Medicine Units SUMMARY AND COMMENT | GENERAL MEDICINE, HOSPITAL MEDICINE INFORMING PRACTICE December 3, 2024 Corticosteroids for Pneumonia in Patients Admitted to General Medicine Units Daniel D. Dressler, MD, MSc, MHM, FACP, reviewing Malecki S et al. J Hosp Med 2024 Nov Patients admitted to medical floors with community-acquired pneumonia did not benefit from systemic corticosteroids. A recent large randomized trial and subsequent meta-analysis demonstrated a survival benefit for systemic corticosteroids in managing severe community-acquired pneumonia (CAP; NEJM JW Gen Med Apr 15 2023 and N Engl J Med 2023; 388:1931), but patients with less-severe disease did not benefit (NEJM JW Gen Med Dec 15 2023 and Clin Infect Dis 2023; 77:1704). In this retrospective cohort study of 11,500 patients with CAP who were admitted to general medicine units in 7 Canadian hospitals, researchers compared outcomes for patients who received systemic corticosteroids (≈10% of patients) and those who did not. Patients admitted to intensive care units and those with chronic lung disease or COVID-19 infection were excluded. In an adjusted analysis, patients who received systemic corticosteroids were significantly more likely to die in the hospital than were patients who didn't receive steroids (8.0% vs. 6.3%; P=0.03). No differences were noted in intensive care admissions, hospital length of stay, or 30-day readmissions. Comment: This study is described as “real-world,” but the authors acknowledge that selection bias and unmeasured confounding likely drove the slightly higher mortality in the corticosteroid group. They went so far as to state that “we do not believe … glucocorticoids caused harm …” In the end, these data will not change my practice of adding steroids for patients who are hospitalized with severe CAP — since this practice is supported by recent guidelines (Crit Care Med 2024; 52:e219) — and withholding steroid therapy in patients who have less-severe CAP. CITATIONS Malecki S et al. Real-world use of glucocorticoids and clinical outcomes in adults hospitalized with community-acquired pneumonia on medical wards. J Hosp Med 2024 Nov; 19:1001. (https://doi.org/10.1002/jhm.13422) https://www.jwatch.org/na58148/2024/12/03/corticosteroids-pneumonia-patients-admitted-general?query=etoc_jwgenmed&jwd=000101747637&jspc=I… 1/3 12/3/24, 7:38 PM Corticosteroids for Pneumonia in Patients Admitted to General Medicine Units SHARE DISCLOSURES TOPICS Aging/Geriatrics, Respiratory Infections LATEST IN GENERAL MEDICINE DEC 3, 2024 New Nonsteroidal Cream for Eczema David J. Amrol, MD NOV 27, 2024 Should Urea Be Used for Managing SIADH? Aaron J. Calderon, MD, FACP, SFHM NOV 27, 2024 Observations from ID and Beyond: Some ID Things to Be Grateful for This Holiday Season — 2024 Edition NOV 26, 2024 Do GLP-1 Agonists Prevent Some Alcohol Use Disorder Hospitalizations? Christopher W. Goodman, MD NOV 26, 2024 Can Zoledronate Protect Against Bone Loss in People Who Discontinue Denosumab? Sarah E. Post, MD Daniel D. Dressler, MD, MSc, MHM, FACP https://www.jwatch.org/na58148/2024/12/03/corticosteroids-pneumonia-patients-admitted-general?query=etoc_jwgenmed&jwd=000101747637&jspc=I… 2/3 12/3/24, 7:38 PM Corticosteroids for Pneumonia in Patients Admitted to General Medicine Units Editor-in-Chief, Hospital Medicine NEJM JOURNAL WATCH HOSPITAL MEDICINE NEJM JOURNAL WATCH GENERAL MEDICINE Biography Disclosures Summaries Guideline Watch 2024 An exclusive collection of 12 clinical guideline summaries that will directly impact how you practice medicine. DOWNLOAD NOW NEJM Journal Watch is produced by NEJM Group, a division of the Massachusetts Medical Society. Copyright © 2024 Massachusetts Medical Society. All rights reserved. The content of this site is intended for health care professionals. Copyright | Terms | Privacy Policy | Cookie Preferences https://www.jwatch.org/na58148/2024/12/03/corticosteroids-pneumonia-patients-admitted-general?query=etoc_jwgenmed&jwd=000101747637&jspc=I… 3/3