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Dexamethasone and length of hospital stay in patients with community acquired pneumonia: a randomised , double-blind,

Sabine C A Meijvis, Hans Hardeman, Hilde H F Remmelts, Rik Heijlingenberg, Ger T Rijkers, Heleen van Velzen-Blad, G Paul Voorn, Ewoudt M W van de Garde, Henrik Endeman, Jan C Grutters, Willem Jan W Bos, Douwe H Biesma The Lancet . June 2011. 377: 2023-30. No sources of funding cited.

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Dexamethasone and length of hospital stay in patients with community acquired pneumonia: a randomised , double-blind,

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  1. Sabine C A Meijvis, Hans Hardeman, Hilde H F Remmelts, Rik Heijlingenberg, Ger T Rijkers, Heleen van Velzen-Blad, G Paul Voorn, Ewoudt M W van de Garde, Henrik Endeman, Jan C Grutters, Willem Jan W Bos, Douwe H Biesma The Lancet. June 2011. 377: 2023-30. No sources of funding cited Dexamethasone and length of hospital stay in patients with community acquired pneumonia: a randomised, double-blind, placebo controlled trial Presented By: Deepa Patel Doctor of Pharmacy Candidate, 2012 Mercer University COPHS

  2. Community Acquired Pneumonia Common Causative bacteria Antibiotic therapy Mainstay for treatment of CAP includes broad spectrum antibiotic(s) based on the patient’s risk factors Doxycycline Macrolides Fluoroquinolones Cephalosporins Clindamycin Beta lactams Vancomycin • Typical • S. pneumonia • H. influenza • M. catarrhalis • Atypical • C. pneumoniae • L. pneumophilia • M. pneumoniae

  3. Level B Class 1 Study

  4. Background/Purpose • Intravenous corticosteroids are frequently used in sepsis/septic shock patients as they are potent inhibitors of inflammation • Previous studies have investigated the role of corticosteroids in community acquired pneumonia, though outcomes with dexamethasone had not been studied • Purpose: Assess the effect of intravenous dexamethasone compared to placebo in length of hospital stay in non-immunocompromised patients admitted to a hospital with community acquired pneumonia

  5. Study Design • 304 patients randomized and blinded • 145 in control group • Received placebo once daily for 4 days • 151 in experimental group • 5 mg dexamethasone once daily for 4 days • Nov 2007 to September 2010 in the Netherlands • Exclusion criteria: immunocompromised status, need for immediate transfer to ICU, and prior immunosuppressive medications

  6. Results Secondary outcomes favoring dexamethasone: greater decline in C-reactive protein and interleukin-6, and statistically significant improvement in social functioning at 30 days following discharge when compared to the placebo group.

  7. Conclusion Use of dexamethasone in addition to antibiotic therapy in patients hospitalized with community acquired pneumonia decreases length of hospital stay by 1 day (p=0.048) when compared to placebo

  8. Commentary • Dexamethasone, along with other corticosteroids plays a role in decreasing inflammation and expediting recovery for patients with CAP • Adverse effects abound with use of this class of medications, including: • Hyperglycemia • GI perforation • Gastric disturbances • Superinfections • Therefore, dexamethasone, and other corticosteroid, use should be judicious in the treatment of inpatient CAP, particularly in patients that have numerous comorbidities

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