Oral dexamethasone reduces Hospital stay in community-acquired pneumonia: Study

Adjunctive intravenous corticosteroid treatment has shown to reduce the length of stay (LOS) in adults hospitalized with community-acquired pneumonia (CAP).

Hence, Esther Wittermans and colleagues from the Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, Netherlands conducted the study to assess the effect of oral dexamethasone on LOS and whether this effect is disease severity dependent.

The authors carried out a multicentre, stratified randomized, double-blind, placebo-controlled trial, which included immunocompetent adults with CAP, all of whom were randomly assigned (1:1 ratio) to receive oral dexamethasone (6 mg once daily) or placebo for 4 days in four teaching hospitals in the Netherlands. 401 patients were randomized to receive dexamethasone (n=203) or placebo (n=198). Randomization (blocks of four) was stratified by CAP severity (pneumonia severity index class I–III and IV-V). The primary outcome was LOS.

The results showed that –

4. Median LOS was shorter in the dexamethasone group (4.5 days (95% CI 4.0–5.0)) than in the placebo group (5.0 days (95% CI 4.6–5.4); p=0.033).
5. Within both CAP severity subgroups, differences in LOS between treatment, groups were not statistically significant.
6. Secondary ICU admission rate was lower in the dexamethasone arm (5 (3%) versus 14 (7%), p=0.030), 30-day mortality did not differ between groups.
7. In the dexamethasone group rate of hospital readmission tended to be higher (20 (10%) versus 9 (5%); p=0.051) and hyperglycaemia (14 (7%) versus 1 (1%); p=0.001) was more prevalent.

Therefore, the authors concluded that "Oral dexamethasone reduced LOS and ICU admission rate in adults hospitalized with CAP."

It remains unclear for which patients the risk-benefit ratio is optimal, they further added.