{"id":15331,"date":"2025-11-13T11:28:14","date_gmt":"2025-11-13T04:28:14","guid":{"rendered":"https:\/\/vinphaco.net\/?p=15331"},"modified":"2025-11-13T11:28:14","modified_gmt":"2025-11-13T04:28:14","slug":"glucocorticoids-and-community-acquired-pneumonia","status":"publish","type":"post","link":"https:\/\/vinphaco.net\/fr\/glucocorticoids-and-community-acquired-pneumonia\/","title":{"rendered":"Glucocorticoids and severe community-acquired pneumonia (sCAP)"},"content":{"rendered":"

This article updates the latest scientific evidence and treatment guidelines regarding the role of glucocorticoids in the treatment of severe community-acquired pneumonia (sCAP).<\/p>\n

Pneumonia is an acute inflammatory disease of the lung parenchyma, commonly caused by pathogenic microorganisms such as bacteria, viruses, or fungi. The inflammatory process leads to infiltration of inflammatory cells and pulmonary edema (Figure 1). Despite many advances in diagnosis and treatment, pneumonia remains one of the leading causes of morbidity and mortality worldwide, particularly in the elderly and patients with underlying diseases.<\/p>\n

\"\"<\/p>\n

Figure 1. Comparison of a healthy lung and lung with pneumonia<\/strong><\/p>\n

The disease may rapidly progress to serious complications such as septic shock and acute respiratory distress syndrome (ARDS), both of which have high mortality rates and often require intensive care. In the management of bacterial pneumonia, antibiotics remain the cornerstone of treatment, but adjunctive therapies, including corticosteroids, are increasingly gaining attention, especially in cases of severe community-acquired pneumonia (CAP). Identifying the optimal treatment strategy to\u00a0 reduce the disease burden and improve patient outcomes remains a primary priority in clinical practice.<\/p>\n

In 2025, Gu et al. published a systematic review and meta-analysis conducted on randomized controlled trials (RCTs) to address this question. The study was conducted according to PRISMA guidelines, selecting RCTs that evaluated the efficacy of glucocorticoids in adult sCAP patients, excluding observational studies, case reports, as well as immunocompromised patients or those who had prior exposure to\u00a0 systemic corticosteroids.<\/p>\n

A total of 8 RCTs involving 1,769 patients were included in the analysis. Results\u00a0 demonstrated that the glucocorticoid group had a significantly lower mortality rate compared to the control group (RR=0.59; 95%CI 0.47\u20130.76; p<0.01). The most pronounced benefit was observed in the hydrocortisone treatment group, with a mortality rate of only 6.3% compared to 14.6% in the control group (RR=0.43; p<0.01), whereas methylprednisolone did not show a significant difference. Furthermore, moderate doses (140\u2013280 mg hydrocortisone\/day) were clearly associated with reduced mortality, while low or excessively high doses did not confer similar benefits.<\/p>\n

\"\"
Figure 2. Forest plot of mortality between the corticosteroids group and the control group<\/strong><\/figcaption><\/figure>\n

In addition to clinical evidence,\u00a0 the latest treatment guidelines also emphasize the role of glucocorticoids in the\u00a0 management of sCAP. The French Infectious Disease Society (SPILF) and the\u00a0 French Society of Respiratory Diseases(SPLF), in coordination with multiple specialty societies, published an updated recommendation for the management of CAP in adults, replacing the 2010 version. The new recommendations highlight several key topics: initial antibiotic selection, combination therapy, indication for anti-Pseudomonas aeruginosa beta-lactam, duration of antibiotic treatment, and notably, the role of systemic corticosteroids. This is a synthesis of the latest scientific evidence aimed at optimizing CAP patients care.<\/p>\n

\"\"<\/p>\n

Figure 3.\u00a0 Scale for grading recommendations and levels of scientific evidence<\/strong><\/p>\n

The 2025 guidelines from SPILF and SPLF provide specific recommendations, classified according to the level of scientific evidence (Figure 3):<\/p>\n