Glucocorticoid treatment in community-acquired pneumonia without severe sepsis: No evidence of efficacy

The study by Snijders and colleagues finds no evidence of efficacy for prolonged glucocorticoid treatment in hospitalized CAP patients without severe sepsis. We believe that, at present, there is no evidence to support the use of glucocorticoids in such patients. An exception, however, would apply to patients with documented adrenal insufficiency. Although Snijders and colleagues found no benefit of glucocorticoids in the smaller subgroup of patients with respiratory failure, lack of information about baseline characteristics and adequacy of antibiotic treatment makes it difficult to effectively appraise these data. Two recent meta-analyses have extensively reviewed the literature on prolonged glucocorticoid treatment in patients with severe sepsis (n = 1,228) and acute lung injury–acute respiratory distress syndrome (n = 648) frequently caused by severe pneumonia. We believe that the findings of this study do not change the conclusions of recent consensus guidelines for patients admitted to the ICU with severe CAP with either shock or acute lung injury .