Corticosteroids and community-acquired pneumonia

Abstract

In pneumonia, the initiation, maintenance, and resolution of inflammation depend on the expression of a complex network of proinflammatory and anti-inflammatory cytokines. A balance between those cytokines is necessary to protect the host from an overzealous inflammatory response with potential harmful effects. The outcome of patients with pulmonary infection depends upon this fine tuning of inflammation. The role of corticosteroids in the treatment of patients with community-acquired pneumonia is unknown, and there is no evidence to support its use in these patients. However, there appears to be a potential role for corticosteroids in some related conditions, such as severe sepsis, adult respiratory distress syndrome, and bronchiolitis obliterans-organizing pneumonia. Further studies are needed to assess not only which patients might benefit from glucocorticoids but also the optimal dose and duration of treatment.