Efficacy and safety of corticosteroid treatment in community-acquired pneumonia

Abstract

Background. Community‑acquired pneumonia (CAP) remains a leading cause of morbidity and mortality worldwide. Adjunctive systemic corticosteroids (CS) have been proposed to dampen the host’s excessive inflammatory response, potentially accelerating recovery, but uncertainty persists regarding net clinical benefit. Objective(s). To evaluate, using current evidence, the efficacy of adjunctive corticosteroids treatment on key clinical outcomes and their safety profile in adults hospitalized with community‑acquired pneumonia. Materials and methods. Systematic PubMed, Embase and Cochrane search (2000‑2025) identified studies of CAP comparing CS plus antibiotics with antibiotics alone, using Keywords: corticosteroids, community‑acquired pneumonia, safety. Endpoints: mortality, clinical stability time, hospital stay, and adverse events findings were narratively synthesized. Results. Across 11 randomized trials (≈2,100 patients) and 8 meta‑analyses, adjunctive CS shortened time to the clinical stability by about 1–1.5 days and reduced hospital stay by roughly 1 day versus placebo. Mortality benefit was modest, becoming significant only in severe CAP or CRP > 150 mg/L (RR 0.72, 95 % CI 0.56‑0.93). Treatment failure, mechanical ventilation, and ICU admission showed favorable but heterogeneous reductions. Adverse events were dominated by transient hyperglycemia (number needed to harm ≈ 16); rates of gastrointestinal bleeding or secondary fungal/bacterial infection were not significantly increased. Conclusion(s). Adjunctive systemic corticosteroids seem to accelerate recovery and may lower mortality in severe or highly inflammatory CAP, at the cost of manageable hyperglycemia and no clear rise in major complications. Judicious, closely monitored use in selected in‑patients is warranted.