Dexamethasone in community-acquired pneumonia/Authors' reply

Evidence suggests that corticosteroid use in infl uenza pneumonia cannot control excessive infl ammation, but compromises the immune response, leading to longer viral shedding, secondary bacterial and fungal infections, and even increased mortality (webappendix).3,4 Controlled studies are needed to address the use of corticosteroids in viral pneumonia and its safety. Notably, in viral pneumonia caused by the coronavirus that causes severe acute respiratory syndrome, increased viral load has been documented with corticosteroid treatment in a randomised trial.5 Given the diff erences in immunopathogenesis between viral and bacterial pneumonia, and the uncertainties in effi cacy and safety,4 we recommend that corticosteroids should not be used routinely in known viral community-acquired pneumonia, especially infl uenzarelated. In this regard, availability of rapid and reliable diagnostics for the causes of communityacquired pneumonia is important to guide antimicrobial treatments (targeted, susceptible antibacterials; or antivirals such as neuraminidase inhibitors), and the use of adjuvant corticosteroids.2,4 We declare that we have no confl icts of interest. *Nelson Lee, David S C Hui leelsn@cuhk.edu.hk Department of Medicine and Therapeutics and Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, Hong Kong 1 Meijvis SC, Hardeman H, Remmelts HH, et al.