Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia

Lee, Mi Suk; Oh, Jee Youn; Kang, Cheol-In; Kim, Eu Suk; Park, Sunghoon; Rhee, Chin Kook; Jung, Ji Ye; Jo, Kyung-Wook; Heo, Eun Young; Park, Dong-Ah; Suh, Gee Young; Kiem, Sungmin

Study results regarding the use of steroids for severe community-acquired pneumonia vary greatly. In a recently-conducted large-scale study, use of steroids in addition to pneumonia treatment led to faster bacteriological conversion, shortened the time until clinical stability, and shortened the duration of hospital stay [189] [190] [191] [192] . In a small-scale randomized study involving patients admitted to an ICU, seven-day use of hydrocortisone reduced the duration of hospital stay and mortality rate [193] . In two small-scale studies, use of steroids produced better treatment outcomes as opposed to when they were not used [194, 195] . However, these studies are small in scale, and differ in the characteristics of their patient groups. In a relatively recently conducted randomized controlled study, the duration of hospital stay was reduced by 1-1.5 days in the steroid group, but no difference in the mortality rate was observed [190, 193] . In addition, when steroids were additionally used for patients with pneumonia, no significant differences in symptom improvements, overall cure rate, complications, rate of ICU admission, and mortality rate were observed compared with the other group that was not subjected to steroid administration, and the rates of hyperglycemia and side effects were higher in the steroid group [189] [190] [191] [192] . However, in a randomized controlled study involving patients with septic shock, seven-day use of low-dose hydrocortisone reduced mortality rates in patients who had hypoadrenalism [196] , and reduced mortality rates and the number of days on mechanical ventilation in patients with acute respiratory failure in addition to hypoadrenalism [197] . Therefore, patients with severe community-acquired pneumonia accompanied by shock that requires vasopressors, use of steroids may be considered.