# Do corticosteroids help in community-acquired pneumonia?

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**Summary:** In severe CAP requiring intensive care, adjunctive corticosteroids reduce mortality; benefit in non-severe disease is weaker.

In adults with severe community-acquired pneumonia (CAP) requiring ICU-level care, adjunctive corticosteroids reduce mortality. In the CAPE COD trial, early intravenous hydrocortisone in patients with severe CAP significantly lowered 28-day mortality compared with placebo, and reduced progression to intubation and vasopressor need [1].

The benefit is most clearly established in severe CAP; evidence in non-severe, ward-level pneumonia is weaker and the mortality benefit there is uncertain. Patients with influenza were largely excluded, and steroids are generally avoided in suspected viral pneumonia where harm has been signalled [1].

Harms include hyperglycaemia requiring insulin; the trial did not show excess hospital-acquired infections or gastrointestinal bleeding over the short course [1]. Corticosteroids should not be used routinely in all CAP without regard to severity.

## Limitations

- The strongest evidence is confined to severe CAP; routine use in mild-to-moderate disease is not supported to the same degree.
- Findings may not extend to influenza or other viral pneumonias, which were excluded or where steroids may be harmful.

## Sources

1. [IV / Randomised trial] Hydrocortisone in Severe Community-Acquired Pneumonia (CAPE COD). New England Journal of Medicine (2023). PMID 36942789. https://pubmed.ncbi.nlm.nih.gov/36942789/

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