Critically evaluate the role of corticosteroids in the management of severe community-acquired pneumonia.
Rationale / Indications
Conventional & generally accepted indications include:
Outside of these groups, in a general population with CAP:
Potential adverse effects
Evidence
A 2015 Meta-analyses (Siemieniuk et al, 2015):
A recent RCT (Blum et al, Lancet 2015, 392 pt per group) showed a shorter time to reach a composite endpoint of ‘clinical stability’ with Prednisolone 50mg daily for 7 days.
Another RCT (Torres et al, JAMA 2015, 60 pt per group) showed that Methylprednisolone 0.5mg/kg 12h for 5 days reduced risk of “treatment failure” compared with placebo in patients with severe CAP and high CRP levels
Practical (Translational) Issues
Additional comments:
Candidates were lacking in knowledge relating to the evidence for steroids in severe CAP. The detail in above template was not required for a pass mark. Satisfactory answer for a pass mark was expected to include:
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