Sabine C A Meijvis, Hans Hardeman, Hilde H F Remmelts, Rik Heijlingenberg, Ger T Rijkers, Heleen van Velzen-Blad, G Paul Voorn, Ewoudt M W van de

Garde, Henrik Endeman, Jan C Grutters, Willem Jan W Bos, Douwe H Biesma

The Lancet. June 2011. 377: 2023-30.

No sources of funding cited

Presented By:Deepa Patel

Doctor of Pharmacy Candidate, 2012Mercer University COPHS

COMMON CAUSATIVE BACTERIA

Typical S. pneumonia H. influenza M. catarrhalis

Atypical C. pneumoniae L. pneumophilia M. pneumoniae

ANTIBIOTIC THERAPY

Mainstay for treatment of CAP includes broad spectrum antibiotic(s) based on the patient’s risk factors

Doxycycline Macrolides Fluoroquinolones Cephalosporins Clindamycin Beta lactams Vancomycin

Intravenous corticosteroids are frequently used in sepsis/septic shock patients as they are potent inhibitors of inflammation

Previous studies have investigated the role of corticosteroids in community acquired pneumonia, though outcomes with dexamethasone had not been studied

Purpose: Assess the effect of intravenous dexamethasone compared to placebo in length of hospital stay in non-immunocompromised patients admitted to a hospital with community acquired pneumonia

304 patients randomized and blinded 145 in control group ▪ Received placebo once daily for 4 days

151 in experimental group ▪ 5 mg dexamethasone once daily for 4 days

Nov 2007 to September 2010 in the Netherlands

Exclusion criteria: immunocompromised status, need for immediate transfer to ICU, and prior immunosuppressive medications

Secondary outcomes favoring dexamethasone: greater decline in C-reactive protein and interleukin-6, and statistically significant improvement in social functioning at 30 days following discharge when compared to the placebo group.

Use of dexamethasone in addition to antibiotic therapy in patients

hospitalized with community acquired pneumonia decreases length of

hospital stay by 1 day (p=0.048) when compared to placebo

Dexamethasone, along with other corticosteroids plays a role in decreasing inflammation and expediting recovery for patients with CAP

Adverse effects abound with use of this class of medications, including: Hyperglycemia GI perforation Gastric disturbances Superinfections

Therefore, dexamethasone, and other corticosteroid, use should be judicious in the treatment of inpatient CAP, particularly in patients that have numerous comorbidities