Question: Do steroids improve clinical outcomes in cases of pediatric pneumonia?
A Cochrane meta-analysis by Stern et al suggests that corticosteroids in adults with severe community-acquired pneumonia (CAP) appear to significantly reduce mortality.1 Is this true in children?
A 36-hospital multicenter study by Weiss et al retrospectively evaluated 20,703 children ages 1 to 18 years.2 The primary outcomes were length of stay (LOS), readmission within 28 days, and total hospital cost in patients who received antibiotics with and without systemic corticosteroids. Overall, systemic corticosteroid therapy was associated with a decrease in LOS (hazard ratio [HR] 1.26; 95% CI, 1.20–1.32). Beta agonists alone were not associated with a significant difference in LOS, but in patients who received beta agonists at initial presentation, the addition of systemic corticosteroids did decrease LOS (HR 1.36; 95% CI, 1.28–1.45). In children who did not receive beta agonists, adjunct systemic corticosteroids were associated with a significantly longer LOS (HR 0.85; 95% CI, 0.75–0.96). These findings may suggest a concomitant reactive airway disease or asthma component affecting LOS in these children with CAP.
An outpatient clinic study by Ambroggio et al studied adjunct systemic corticosteroids with antibiotics in CAP.3 The authors retrospectively studied 2,244 children, and treatment failure leading to hospital admission occurred in only two patients.