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Corticosteroid for community acquired pneumonia

Antoni Torres, James D Chalmers, Charles S Dela Cruz, Cristina Dominedò, Marin Kollef, Ignacio Martin-Loeches, Michael Niederman, Richard G Wunderink
PURPOSE: Severe community-acquired pneumonia (SCAP) is still associated with substantial morbidity and mortality. In this point-of-view review paper, a group of experts discuss the main controversies in SCAP: the role of severity scores to guide patient settings of care and empiric antibiotic therapy; the emergence of pathogens outside the core microorganisms of CAP; viral SCAP; the best empirical treatment; septic shock as the most lethal complication; and the need for new antibiotics...
January 31, 2019: Intensive Care Medicine
Karin A Provost, Miyuki Smith, Anna Miller-Larsson, Gregory D Gudleski, Sanjay Sethi
RATIONALE: Patients with COPD have an increased risk for community-acquired pneumonia, which is further increased by inhaled corticosteroids. OBJECTIVE: To assess effects of the corticosteroids, budesonide and fluticasone propionate, on macrophage bacterial responses in COPD. METHODS: Monocyte-derived macrophages (MDMs) generated from blood monocytes from 10 non-smoker controls (NoS), 20 smokers without COPD (Sm), and 40 subjects with moderate to severe COPD (21 ex-smokers (COPD-ES) and 19 current smokers (COPD-S)) were pre-treated with budesonide or fluticasone (10 nM-1 μM) and challenged with live non-typeable Haemophilus influenzae (NTHI) or Streptococcus pneumoniae (SP)...
2019: PloS One
Peter Tepler, Shahriar Zehtabchi
Pneumonia remains a major cause of morbidity and mortality in the United States. There is both theoretical and laboratory evidence that corticosteroids may have beneficial effects in pneumonia through local pulmonary and systemic effects. The data for this evidence-based summary is derived from a Cochrane meta-analysis by Stern et al,4 which included 17 trials with 2264 adult and children admitted to the hospital with community-acquired pneumonia. This article is protected by copyright. All rights reserved...
December 26, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Pablo Idoyaga, Mariano Fielli, Alejandra González, Leila R Ferreyra Mufarregue, Marcelo Fernández Casares, Gabriela Crevena
IgG4-related disease is a heterogeneous group of diseases that can affect a single organ or manifest as a systemic disease. We present the case of a 55-yearold female, admitted for dry cough, fever, progressive dyspnea and respiratory failure. Chest CT showed areas of diffuse ground glass, reticular pattern and alveolar consolidation. She received treatment for community acquired pneumonia and systemic corticosteroids with good response. One month later, she was admitted again due to subglottic stenosis, progression of pulmonary infiltrates, and increased palpebral and submaxillary glands volume...
2018: Medicina
Elina Eleftheria Pliakos, Nikolaos Andreatos, Giannoula S Tansarli, Panayiotis D Ziakas, Eleftherios Mylonakis
BACKGROUND: The use of corticosteroids as adjunct treatment for community-acquired pneumonia (CAP) is associated with potential clinical benefits and the aim of this study was to evaluate the cost-effectiveness of this approach. METHODS: We constructed a decision-analytic model comparing the use of corticosteroids+antibiotics to that of placebo+antibiotics for the treatment of CAP. Cost-effectiveness was determined by calculating deaths averted and incremental cost-effectiveness ratios (ICER)...
November 15, 2018: Chest
Adrian Ceccato, Miquel Ferrer, Enric Barbeta, Antoni Torres
The use of adjuvant therapies for community-acquired pneumonia is still in development. Combinations of antibiotics with macrolides seem to be the best option when there is no risk of resistance. The use of corticosteroids is the treatment of choice in patients with severe pneumonia and a high inflammatory response who do not present contraindications for these drugs. Other drugs await confirmation of their benefit and should be used only on exceptional occasions at this time.
December 2018: Clinics in Chest Medicine
Richard G Wunderink
Few guidelines have greater acceptance than that for management of community-acquired pneumonia (CAP). Despite this, areas remain controversial, and new challenges continue to emerge. Current guidelines differ from those of northern European countries predominantly in need for macrolide combination with β-lactams for hospitalized, non-intensive care unit patients. A preponderance of evidence favors combination therapy. Challenges for current and future CAP guidelines include new antibiotic classes, emergence of viruses as major causes for CAP, new diagnostic modalities, alternative risk stratification for pathogens resistant to usual CAP antibiotics, and evidence-based management of severe CAP, including immunomodulatory therapy such as corticosteroids...
December 2018: Clinics in Chest Medicine
Adamantia Liapikou, Catia Cilloniz, Antoni Torres
Community-acquired pneumonia (CAP), a major cause of morbidity and mortality, is the leading infectious cause of death in the developed world. Population-based studies and systematic reviews have identified a large number of risk factors for the development of pneumonia in adults. In addition to age, lifestyle habits, and comorbidities, some forms of pharmacotherapy may also increase the risk for CAP. Areas covered: MEDLINE, CENTRAL, and Web of Science were used in 2017 to search for case-control, cohort studies, as well as randomized controlled trials and meta-analysis that involved outpatient proton pump inhibitors (PPIs), inhaled corticosteroids (ICSs), antipsychotics, oral antidiabetics, and CAP diagnosis in patients aged >18 years...
October 2018: Expert Opinion on Drug Safety
Roberto Cangemi, Marco Falcone, Gloria Taliani, Camilla Calvieri, Giusy Tiseo, Giulio Francesco Romiti, Giuliano Bertazzoni, Alessio Farcomeni, Francesco Violi
RATIONALE: Adults hospitalized for community-acquired pneumonia (CAP) have an increased risk of myocardial infarction. Corticosteroid treatment lowers CAP morbidity and mortality, but it is not known whether it influences in-hospital myocardial infarction. OBJECTIVES: The aim of the present study was to investigate the potential interplay between corticosteroid treatment and in-hospital myocardial infarction in adults with CAP. METHODS: We retrospectively analyzed adults with CAP referred to the University Hospital Policlinico Umberto I (Rome, Italy), consecutively recruited, and prospectively followed until discharge...
January 2019: Annals of the American Thoracic Society
Jose Garnacho-Montero, Irene Barrero-García, Maria de Gracia Gómez-Prieto, Ignacio Martín-Loeches
Despite advances in modern medicine, severe community-acquired pneumonia (CAP) continues to be a potentially deadly disease. Mortality rate reaches up to the 50% in patients requiring admission to the Intensive Care Unit (ICU) when developing septic shock. Areas covered: We aim to describe the optimal management of severe CAP, including antibiotic therapy, future antimicrobial options, and non-antibiotic (so-called adjunctive) therapies. A literature search was performed to identify all clinical trials, observational studies, meta-analysis, and reviews about this topic from PubMed...
September 2018: Expert Review of Anti-infective Therapy
Alexander F A D Schauwvlieghe, Bart J A Rijnders, Nele Philips, Rosanne Verwijs, Lore Vanderbeke, Carla Van Tienen, Katrien Lagrou, Paul E Verweij, Frank L Van de Veerdonk, Diederik Gommers, Peter Spronk, Dennis C J J Bergmans, Astrid Hoedemaekers, Eleni-Rosalina Andrinopoulou, Charlotte H S B van den Berg, Nicole P Juffermans, Casper J Hodiamont, Alieke G Vonk, Pieter Depuydt, Jerina Boelens, Joost Wauters
BACKGROUND: Invasive pulmonary aspergillosis typically occurs in an immunocompromised host. For almost a century, influenza has been known to set up for bacterial superinfections, but recently patients with severe influenza were also reported to develop invasive pulmonary aspergillosis. We aimed to measure the incidence of invasive pulmonary aspergillosis over several seasons in patients with influenza pneumonia in the intensive care unit (ICU) and to assess whether influenza was an independent risk factor for invasive pulmonary aspergillosis...
October 2018: Lancet Respiratory Medicine
Paul E Marik
Glucocorticoids have been used as adjunctive therapy in patients with sepsis and septic shock for more than four decades. The rationale for the use of glucocorticoids is that this class of drugs downregulates the proinflammatory response and limits the anti-inflammatory response while preserving innate immunity. Between 1976 and 2017, 22 randomised placebo-controlled trials have been published evaluating the benefit of glucocorticoids in patients with community-acquired pneumonia, sepsis, and septic shock. These studies produced conflicting results...
October 2018: Lancet Respiratory Medicine
Nicola Principi, Susanna Esposito
Community-acquired pneumonia (CAP) remains one of the most common reasons for paediatric morbidity and accounts for about 16% of all the deaths occurring in children less than 5 years of age. Areas covered: The main aim of this paper is to discuss the emerging problems for CAP treatment in paediatric age. Expert commentary: Official recommendations for therapeutic approaches to paediatric CAP, despite being not very recent, seem still to be the best solution to assure the highest probabilities of cure for children with this disease living in industrialized countries...
July 2018: Expert Review of Respiratory Medicine
Kirsten Koehorst-Ter Huurne, Catharina Gm Groothuis-Oudshoorn, Paul Dlpm vanderValk, Kris Ll Movig, Job van der Palen, Marjolein Brusse-Keizer
Aim: The aim of this study was to analyze the association between therapy adherence to inhaled corticosteroids (ICSs) and tiotropium on the one hand and morbidity and mortality in COPD on the other hand. Methods: Therapy adherence to ICSs and tiotropium over a 3-year period of, respectively, 635 and 505 patients was collected from pharmacy records. It was expressed as percentage and deemed optimal at ≥75-≤125%, suboptimal at ≥50%-<75%, and poor at <50% (underuse) or >125% (overuse)...
2018: International Journal of Chronic Obstructive Pulmonary Disease
J Liu, J Zhang, Q J Cheng, J F Xu, Z J Jie, Y Jiao, Y Huang, J M Qu
Objective: To understand the current status of diagnosis and treatment of community-acquired pneumonia (CAP) among doctors in various hospitals across Shanghai, for the purpose of promoting the 2016 clinical practice guidelines for adult CAP of China. Methods: A questionnaire was designed to address the common questions in CAP management. The responses were collected via WeChat and the data were analyzed. Results: A total of 1 254 valid questionnaires were received, 46.1% from tertiary , 26.4% from secondary and 27...
April 12, 2018: Chinese Journal of Tuberculosis and Respiratory Diseases
Rosa Morros, Cristina Vedia, Maria Giner-Soriano, Aina Casellas, Ester Amado, Jose Miguel Baena
OBJECTIVES: To analyse the risk of pneumonia and/or exacerbations in patients with chronic obstructive pulmonary disease (COPD) who receive treatment with inhaled corticosteroids (CI), in comparison with those who are not treated with inhaled corticosteroids (NCI). To estimate the risk of pneumonia according to CI dose. DESIGN: Population-based cohort study. SETTING: Primary Healthcare. Institut Català de la Salut. PARTICIPANTS: Patients ≥45 years-old diagnosed with COPD between 2007 and 2009 in the Information System for Research in Primary Care (SIDIAP)...
April 13, 2018: Atencion Primaria
L J Li, Y M Liu, Y M Wang, F Zhou, H Li, X Q Xing, X D Han, L Chen, C X Zhang, J X Wang, B Liu, L J Suo, G H Yu, G Q Wang, X X Yao, Y Xiao, X L Zhu, C X Xue, X J Cui, B Cao
Objective: To explore the clinical features, etiological features and prognostic risk factors of long-term glucocorticoid users with community-acquired pneumonia (CAP). Methods: A retrospective study included 100 long-term glucocorticoid users with CAP (G-CAP group) from 11 hospitals of China between January 2014 and December 2014, while 100 non-immunocompromised patients with community-acquired pneumonia were enrolled as controls (nICH-CAP group). Characteristics including age, gender, underlying diseases, corticosteroids, symptoms, disease severity, imaging manifestations, etiology, respiratory failure, mechanical ventilation, whether the application of vasoactive drugs, antibiotics application, hospital mortality rate between the two groups were compared, and the prognostic factors of G-CAP were investigated using Logistic regression...
March 13, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Said Alyacoubi, Yousef Abuowda, Loai Albarqouni, Bettina Böttcher, Khamis Elessi
BACKGROUND: Disease severity scores such as CURB-65 are often used to guide the management of patients with community-acquired pneumonia. Early and adequate empirical antibiotic treatment reduces mortality. The aim of this study was to examine the severity assessment and management of patients presenting with community-acquired pneumonia at the European Gaza Hospital in the Gaza Strip and to compare this to the best available evidence. METHODS: Medical records of all patients admitted to the European Gaza Hospital with a diagnosis of community-acquired pneumonia between Dec 1, 2015, and March 31, 2016, were reviewed retrospectively...
February 21, 2018: Lancet
Yusuke Okubo, Nobuaki Michihata, Naho Morisaki, Kazuhiro Uda, Isao Miyairi, Yuichi Ogawa, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
BACKGROUND: Mycoplasma pneumoniae is a major pathogen causing community-acquired pneumonia/bronchitis in children, and macrolide-resistant strains are increasing in East Asian countries. Recent practice patterns, especially for antibiotic selection, and benefits of corticosteroid treatment in pediatric Mycoplasma pneumoniae infections remain unclear. METHODS: Using the Japanese Diagnosis Procedure Combination inpatient database, we analyzed recent trends in antibiotic selection and corticosteroid use for pediatric Mycoplasma pneumoniae-related respiratory infections, using multivariable mixed effects logistic regressions...
March 2018: Respiratory Investigation
Catia Cilloniz, Miquel Ferrer, Adamanthia Liapikou, Carolina Garcia-Vidal, Albert Gabarrus, Adrian Ceccato, Jorge Puig de La Bellacasa, Francesco Blasi, Antoni Torres
Our aim was to assess the incidence, characteristics, aetiology, risk factors and mortality of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU) patients with community-acquired pneumonia (CAP) using the Berlin definition.We prospectively enrolled consecutive mechanically ventilated adult ICU patients with CAP over 20 years, and compared them with mechanically ventilated patients without ARDS. The main outcome was 30-day mortality.Among 5334 patients hospitalised with CAP, 930 (17%) were admitted to the ICU and 432 required mechanical ventilation; 125 (29%) cases met the Berlin ARDS criteria...
March 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
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