Daily Dose: Hydrocortisone Outperforms Other Corticosteroids for Community-Acquired Pneumonia

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On October 23, 2023, we reported on findings presented at the CHEST 2023 Annual Meeting, held October 8-11 in Honolulu, Hawaii.

The study

Investigators conducted a systematic review and meta-analysis using PubMed, Cochrane Library, and Embase databases to examine whether treatment with hydrocortisone, compared to other corticosteroids, has differential effects on clinical outcomes of patients with community-acquired pneumonia (CAP).

The primary endpoint was all-cause mortality and secondary endpoints included the need for mechanical intervention and adverse events (eg, secondary infections, gastrointestinal bleeding).

Researchers identified 17 RCTs that evaluated the efficacy of systematic corticosteroids for management of CAP.

Of the 17 trials, 6 reported on the use of hydrocortisone, 6 on prednisolone, 3 on methylprednisolone, and 2 on dexamethasone.

Findings

Results showed hydrocortisone was associated with a lower risk of all-cause mortality, whereas other corticosteroids—prednisolone, methylprednisolone, and dexamethasone—were not associated with a reduced risk of all-cause mortality. Hydrocortisone was also associated with a lower need for mechanical ventilation, however, researchers did not observe any association with the other corticosteroids.

In terms of adverse events, investigators noted that both hydrocortisone and other corticosteroids were not associated with an increased risk of secondary infections or gastrointestinal bleeding.

Authors' comment

"Corticosteroids have been reported to have no effects on survival outcomes of hospitalized patients with CAP. We found that hydrocortisone, a low-cost and generally well-tolerated medication, had a significant mortality benefit compared to other types of corticosteroids in CAP."

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