Indications for Steroids in Pneumonia

Primary Indications for Steroids in Pneumonia

• The European Respiratory Society suggests that steroids have no place in the treatment of pneumonia unless septic shock is present 1, 2
• Septic shock refractory to fluid resuscitation and vasopressors may be treated with steroids, as recommended by the Intensive Care Medicine society 3
• Severe community-acquired pneumonia with high inflammatory markers may be treated with steroids, according to the Praxis Medical Insights guidelines, however, a non-Praxis source is preferred, in this case, Intensive Care Medicine recommends steroids for Pneumocystis jiroveci pneumonia with hypoxemia 3

Dosing Recommendations

• For septic shock, the Intensive Care Medicine society recommends Hydrocortisone <400 mg daily, however a non-Praxis source is preferred, in this case, the same dosing is recommended by the European Respiratory Journal for severe CAP with high inflammatory response is not the primary source, instead, Methylprednisolone 0.5 mg/kg IV every 12 hours or prednisone 50 mg daily for 5-7 days is recommended by Intensive Care Medicine for Pneumocystis jiroveci pneumonia 3

Evidence of Benefit

• The European Respiratory Journal found decreased mortality in severe CAP (OR = not available), however, a similar finding was reported by Intensive Care Medicine, which found that steroids improved outcomes in patients with severe pneumonia 3

Contraindications and Cautions

• The European Respiratory Society recommends that steroids are NOT indicated for non-severe pneumonia 1, 2
• High-dose steroid regimens (>400 mg hydrocortisone equivalent daily) are not recommended by the Intensive Care Medicine society 3

Monitoring During Treatment

• The Journal for ImmunoTherapy of Cancer recommends considering prophylactic antibiotics for pneumocystis pneumonia for patients receiving ≥20 mg methylprednisolone or equivalent for ≥4 weeks 5
• The Journal for ImmunoTherapy of Cancer also recommends considering calcium and vitamin D supplementation with prolonged steroid use 5
• Proton pump inhibitor therapy for GI prophylaxis in patients with grade 2-4 pneumonitis receiving steroids is recommended by the Journal for ImmunoTherapy of Cancer 5