Improving the outcome of patients with community-acquired pneumonia (CAP) is an ongoing
challenge, even in the setting of significant advances in antimicrobial chemotherapy and critical care.
Recognition of the underlying involvement of inflammation-mediated organ dysfunction as a determinant
of adverse outcomes in CAP has aroused intense interest in the protective potential of adjunctive antiinflammatory
therapies in CAP, particularly the role of corticosteroids (CS). This is the primary topic of the
current review which is focused on an evaluation of the latest meta-analyses encompassing both recent and
earlier clinical trials, with particular emphasis on the stringent meta-analysis undertaken by Siemieniuk and
colleagues (Ann Intern Med 2015;163:519–528). The review highlights the findings and recommendations
of these and related published commentaries/critiques, while providing a brief description of those subgroups
of patients who seemingly stand to benefit most from CS therapy. This is preceded by an overview
of the mechanisms of the anti-inflammatory activities of CS, the interactions of these agents with macrolide
antibiotics, and the potential benefits and risks of short-term administration of CS, concluding with a
succinct appraisal of priority issues for ongoing and future research.
This is an invited article commissioned by the
Section Editor Wan-Jie Gu (Department of Anesthesiology,
Affiliated Drum Tower Hospital, Medical College of
Nanjing University, Nanjing, China).