I have to say that the addition of a steroid, to a patient with an active infection often feels like an oxymoron. After all, just when the patient is battling a severe illness, why would we want to shut it down? Of course, I am not talking about those cases of relative adrenal insufficiency, where the steroid becomes a treatment for this, and is not functioning primarily as an immunomodulator. Anyway, in the recent study from the Lancet, the steroid used was dexamethasone which has minimal mineralocorticoid effect anyway.
Meijvis and colleagues randomized 304 patients with community acquired pneumonia (CAP) to receive dexamethasone 5 mg IV daily for 5 days, or a placebo in a double blind fashion. This was done in 2 emergency departments, and those in need of immediate admission to an ICU were excluded, which implies that there were few, if any, critically ill patients included in this study.
At any rate, there was no mortality difference, and the dexamethasone patients had a mean length of stay (LOS) of 6.5 days, which was a day shorter than their control counterparts. However, there was a price to be paid as there was a significant increase in hyperglycemia in the steroid group.
Lancet. 2011 Jun 11;377(9782):2023-30. Epub 2011 Jun 1.
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