Corticosteroids for all adult patients with community-acquired pneumonia?

After an interim analysis performed on 46 patients, the trial was stopped due to a significant difference in improvement in the primary endpoint (partial pressure arterial oxygen [PaO2]/fractional inspired oxygen [FiO2] ratio) 8 days after inclusion and a lower in-hospital mortality rate (0 vs. 30%), both favouring the hydrocortisone group. Snijders and colleagues [14] found a faster defervescence but not a faster time to recovery in patients receiving 40 mg of prednisone for 7 consecutive days, and also found a higher risk of late failures after initial improvement. Since this latter finding has not been reproduced in subsequent studies, one proposed explanation for this was a random effect. [...]a meta-analysis published prior to the most recent and largest RCTs did find a mortality benefit for the subgroup of patients with severe CAP, but not in all patients with CAP [20]. [...]future studies will need to define specific subgroups that benefit more from corticosteroid therapy. CAP caused by certain pathogens may have more advantage from corticosteroid therapy, considering the faster decline in cytokines in the atypical pathogens Mycoplasma pneumoniae, Coxiella burnetii, Legionella pneumophila and Chlamydia species compared to Streptococcus pneumoniae on a 4-day course of dexamethasone [22].