Corticosteroids as adjunctive therapy in children with CAP

January 01, 0001

Corticosteroids as adjunctive therapy in children with CAP

These US researchers performed a multicenter, retrospective cohort study examining how systemic corticosteroid therapy affects outcomes in hospitalized children with community-acquired pneumonia (CAP). Data for pediatric patients (aged 1 to 18 years) with CAP was culled from 36 children's hospitals. They looked at length of stay (LOS), readmission, and total hospitalization cost using multivariable regression models and propensity scores.

The researchers found: "The 20,703 patients whose data were included had a median age of 4 years. Adjunct corticosteroid therapy was administered to 7234 patients (35%). The median LOS was 3 days, and 245 patients (1.2%) required readmission. Systemic corticosteroid therapy was associated with shorter LOS overall (adjusted hazard ratio (HR): 1.24). Among children who received treatment with beta-agonists, the LOS was shorter for children who had received corticosteroids compared with children who had not (adjusted HR: 1.36). Among children who did not receive beta-agonists, the LOS was longer for those who received corticosteroids compared with those who did not (adjusted HR: 0.85). Corticosteroids were associated with readmission of patients who did not receive concomitant beta-agonist therapy (adjusted odds ratio: 1.97)."

The researchers concluded: "For children hospitalized with CAP, adjunct corticosteroids were associated with a shorter hospital LOS among patients who received concomitant beta-agonist therapy. Among patients who did not receive this therapy, systemic corticosteroids were associated with a longer LOS and a greater odds of readmission. If beta-agonist therapy is considered a proxy for wheezing, our findings suggest that among patients admitted to the hospital with a diagnosis of CAP, only those with acute wheezing benefit from adjunct systemic corticosteroid therapy."

Corticosteroids are beneficial in pediatric patients with CAP if they are wheezing, and worsen outcomes in absence of wheezing.

For the full abstract, click here.

Pediatrics 127(2):e255-e263, February 2011 © 2011 American Academy of Pediatrics
Adjunct Corticosteroids in Children Hospitalized With Community- Acquired Pneumonia. Anna K. Weiss, Matthew Hall, Grace E. Lee, Matthew P. Kronman, Seth Sheffler-Collins, Samir S. Shah.

Category: R. Respiratory. Keywords: community acquired pneumonia, CAP, corticosteroids, wheezing, pediatrics, retrospective cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 18 March 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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