Hydrocortisone Dosage for Severe Pneumonia

Dosage Recommendations

The American College of Critical Care Medicine recommends hydrocortisone at a daily dose less than 400 mg IV for 5-7 days for severe community-acquired pneumonia, which can lead to benefits including shortened hospital stay, reduced need for mechanical ventilation, and prevention of ARDS 1, 2
For patients with septic shock not responsive to fluid and moderate-to-high-dose vasopressor therapy, the Intensive Care Medicine society suggests use of IV hydrocortisone at less than 400 mg/day for at least 3 days at full dose 3
The Surviving Sepsis Campaign recommends 200 mg per day when hemodynamic stability cannot be restored with adequate fluid resuscitation and vasopressor therapy, with continuous infusion preferred over bolus administration 4

Corticosteroids are not recommended for pneumonia without shock, according to the Critical Care Medicine and Intensive Care Medicine societies 4, 3
The Critical Care Medicine and Military Medical Research societies advise against using corticosteroids in patients with influenza pneumonia 1, 5
The quality of evidence for corticosteroid use in severe CAP is moderate, with low-dose corticosteroids (≤400 mg hydrocortisone equivalent daily) shown to reduce mortality in severe community-acquired pneumonia compared to placebo 1, 2

For COVID-19 pneumonia requiring oxygen or ventilation, the Military Medical Research society recommends dexamethasone 6 mg daily for 10 days (equivalent to approximately 160 mg hydrocortisone) 5