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There is a consensus regarding the need to move beyond antibiotic therapy if we want to improve outcomes of hospitalized patients with community-acquired pneumonia (CAP). However, there is a lack of consensus regarding the use of steroids as adjunctive therapy in patients with CAP. Eleven meta-analyses have been already published in the field of steroids and CAP [1-11]. A primary problem with several of these meta-analyses is the inclusion of studies with important methodological weaknesses. In addition, in a recent meta-analysis which was published in the American Journal of Emergency Medicine [10], the authors incorporated 3 manuscripts which were written in Chinese, making it impossible for us to evaluate the quality of those research studies. At present, we have more meta-analyses published on the topic of steroids and CAP than original randomized clinical trials (RCTs), with some of them arriving to different conclusions. Meta-analyses are considered the highest level of evidence when they are based on high-quality RCTs, but this is not the case in the field of steroids and CAP. Because of the above, the controversy regarding the use of steroids in patients with CAP will continue until further high quality research is published. With all these caveats in mind, after reviewing recent randomized clinical trials [12-19] we consider that there is enough evidence to recommend the use of steroids only in a well selected group of hospitalized patients with CAP. We also consider that the current level of evidence in favor of steroid is weak, and that there is a significant possibility that future studies may alter our current recommendations. In this editorial, we summarize our approach to the use of steroids in hospitalized patients with CAP at the University of Louisville Hospital.

Using Steroids in Patients with Community-Acquired Pneumonia at the University of Louisville Hospital: Who, What, and When