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The use of anti-inflammatory drugs significantly reduces treatment failure in severe pneumonia

The use of corticosteroids, a group of anti-inflammatory drugs, along with antibiotics, significantly reduces treatment failure among patients with severe community-acquired pneumonia from 31% to 13 %, at the same time that improves their prognosis. The Journal of the American Medical Association (JAMA) publishes this study led by researchers from Hospital Clínic of Barcelona, IDIBAPS and the Networked Biomedical Research Center for Respiratory Diseases (CIBERES). Dr. Antoni Torres, Pneumologist at Hospital Clínic of Barcelona, professor at the University of Barcelona and coordinator of the IDIBAPS and CIBERES group that has led this research, is the first author of the paper.

Community-acquired pneumonia is the leading infectious cause of death in developed countries. Up to 60% of patients with pneumonia have to be hospitalized and the overall mortality of those patients is 10% but increases considerably, up to 30%, in the most severe cases and in those who experience treatment failure. In addition, patients with pneumonia after discharge may be affected for a long time of malaise, chronic illnesses decompensation and severe cardiovascular complications.

Pneumonia is usually caused by bacteria, but may also have a viral origin. When pneumonias are caused by bacteria have to be treated with antibiotics and, although properly done, mortality is still high in severe cases. For many years there has been speculation about whether reducing inflammation caused by pneumonia could have beneficial effects on the evolution of these patients.

Thus, in this study, published in JAMA, researchers have compared over an eight-year period (2004-2012) the administration of antibiotics plus placebo versus antibiotics plus corticosteroids in patients with severe pneumonia. The results demonstrate that there is a significant reduction in treatment failure, including mortality, from 31% to 13% in the group of patients receiving corticosteroids. Patients who received corticosteroid treatment had a 66 percent lower odds of treatment failure.

"This study opens a new perspective in the treatment of severe pneumonia and a significant change in the clinical practice to reduce mortality caused by this respiratory infection so common and potentially fatal", explains Dr. Antoni Torres. The study also involved two more hospitals:  La Fe in Valencia and Son Dureta in Palma de Mallorca.

Article reference:

Corticosteroid Decreases Treatment Failure for Patients with Severe Community-Acquired Pneumonia and High Inflammatory Response

Antoni Torres MD, PhD, Oriol Sibila MD, PhD, Miquel Ferrer MD, PhD, Eva Polverino MD, PhD, Rosario Menendez MD, PhD, Josep Mensa MD, PhD, Albert Gabarrús MSc, Jacobo Sellarés MD, PhD, Marcos I Restrepo MD, MSc, Antonio Anzueto MD, PhD, Michael S. Niederman MD and Carles Agustí MD.

JAMA. 2015;313(7):677-686. doi:10.1001/jama.2015.88.