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Dexamethasone reduces LOS in patients with community-acquired pneumonia

Clinical Question:
Does the use of dexamethasone as adjunctive therapy decrease the length of stay in patients hospitalized for community-acquired pneumonia?

Bottom Line:
The addition of dexamethasone to standard antibiotic treatment reduced the length of stay (LOS) in hospitalized patients with community-acquired pneumonia. Although hyperglycemia was more common with the steroids, severe adverse events were infrequent. This study was too small to know if dexamethasone improves other outcomes such as death, transfer to intensive care unit, or readmission. (LOE = 1b)

Reference:
Meijvis SC, Hardeman H, Remmelts HH, et al. Dexamethasone and length of hospital stay in patients with community-acquired pneumonia. Lancet 2011;377(9782):2023-2030.  [PMID:21636122]

Study Design:
Randomized controlled trial (double-blinded)

Funding:
Self-funded or unfunded

Allocation:
Concealed

Setting:
Inpatient (ward only)

Synopsis:
Corticosteroids can reduce the systemic inflammatory response and so may serve as adjunctive therapy for the treatment of pneumonia. In this study from the Netherlands, investigators randomized 304 adults with community-acquired pneumonia requiring hospitalization to receive either intravenous dexamethasone 5 mg or placebo for 4 days. Patients with a history of immunodeficiencies or those receiving immunosuppressants and patients requiring steroid treatment were excluded. Antibiotic selection and the decision to discharge a patient were left to the discretion of the primary medical team. Baseline characteristics of the 2 groups were similar except for more patients with renal disease (13% vs 7%) and more patients with pneumonia severity index risk classes 4 and 5 (52% vs 42%) in the dexamethasone group. Almost 90% of patients in each group completed the 4-day course of treatment. Median length of stay was decreased by 1 day in the dexamethasone group as compared with the placebo group (6.5 days vs 7.5 days; P = .0478). The number of hospital deaths (8 in each group), transfers to the intensive care unit (7 and 10, respectively), and readmissions (7 each) were too small to know if dexamethasone made any difference in these outcomes. As expected, hyperglycemia was more frequent in the dexamethasone group (44% vs 23%; P < .0001).

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