Adjuvant corticosteroids for patients hospitalized with community-acquired pneumonia: is it time?

Community-acquired pneumonia (CAP) is one of the most common infectious diseases leading to hospital admission, and the third-leading cause of death worldwide (1,2). Despite the availability of antibacterial treatment active in vitro for most recognized causes of bacterial CAP, this common disease still carries a significant burden of morbidity and mortality (3). Hence, efforts to develop adjunct therapeutic interventions for CAP have been intensified over the last decades. Of those, corticosteroid therapy is the most promising, with significant clinical benefits demonstrated in various randomized controlled trials (4-8). However, the use of corticosteroids in patients with CAP has not been clearly recommended thus far, neither in the main guidelines for CAP (9,10), nor in state-of-the-art review papers (1-3,11). Even the editorials that came out with randomized trials demonstrating positive impact of corticosteroids on clinical outcomes were rather cautious, and basically recommended additional studies before corticosteroids be recommended for CAP (12,13), with the notable exception of one (14).