Severity of community-acquired pneumonia treated with low-dose adjunctive corticosteroid

Abstract

We read with interest the report of the randomized double-blind controlled trial by Fernandez-Serrano and colleagues [1] suggesting that the administration of methyl-prednisolone (MPDN) with ceftriaxone plus levofl oxacin improves clinical variables in communityacquired pneumonia (CAP). Compared with randomly controlled studies in which patients benefi ted from corticosteroid treatment [2-4], all patients of this study received the same antibiotics. It is striking that this study has overcome the problem that choice and dose of antibiotics may infl uence results. However, several points should be discussed. First, it would be better to consider the severity of CAP because adjunctive corticosteroid treatment should not be routinely administrated to patients with any severity of CAP. In fact, the results of our study suggest that cortico steroid treatment lacks effi cacy in cases of mild to moderate CAP [3]. Although additional subgroup analysis may lead to similar results to those of our study because more than 50% of patients in both studies had a pneumonia severity index [5] rating of IV or V [1,3], the target population for corticosteroid treatment should be precisely identifi ed. Moreover, although the authors administrated 620 mg MPDN per patient, we [3] and Meijvis and colleagues [4] showed a benefi cial eff ect with lower doses of corticosteroids over shorter periods. Th e authors should consider lower doses and shorter periods of MPDN treatment in a future study. Although this study could clearly provide signifi cantly benefi cial evidence of the value of MPDN treatment, the severity of pneumonia should be addressed because of the potential risk associated with corticosteroid treatment.