Systemic corticosteroids and community-acquired pneumonia—cautious optimism or wishful thinking?

The potential use of oral corticosteroids in patients with community-acquired pneumonia (CAP) has become extremely topical. In the past 12 months we have had two randomized controlled trials (1,2), three meta-analysis (3-5) and a significant number of associated editorials and commentaries. While the randomized controlled trials could be described as mildly positive at best, the meta-analyses, and particularly the paper by Siemieniuk and colleagues (4), have been much more vocal in their support of steroid therapy.