Systemic corticosteroid therapy significantly decreased length of hospital stay and fever duration in children with community-acquired pneumonia
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Key Takeaway
Consider possible advantage for corticosteroid therapy in selected pediatric patients with community-acquired pneumonia.
This systematic review and meta-analysis assessed the impact of systemic corticosteroid therapy compared with controls in children with community-acquired pneumonia. The analysis included a sample size of N = 75.353 patients across studies where the setting was not reported.
Key findings indicated a significantly decreased length of hospital stay with a Cohen's d value of -0.59 and a 95% confidence interval of -0.96 to -0.23, P = 0.001. Additionally, the duration of fever was significantly decreased with a Cohen's d value of -0.54 and a 95% confidence interval of -0.83 to -0.26, P < 0.001. Secondary outcomes included radiologic recovery time and clinical recovery time.
The authors noted significant heterogeneity regarding the regimen, dosage, and duration of corticosteroid therapy. Results were not significant in observational studies. Adverse events were described as infrequent and manageable, while serious adverse events, discontinuations, and tolerability were not reported. The study acknowledges limitations related to heterogeneity and the lack of significance in observational data.
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View Original Abstract ↓
BACKGROUND: Corticosteroids are effective adjunct treatment for certain infectious diseases. However, their role in children with community-acquired pneumonia (CAP) remains unclear. We aim to assess the efficacy and safety of adjunct corticosteroid therapy in pediatric CAP.
MATERIALS AND METHODS: A systematic literature search was conducted on MEDLINE to retrieve studies assessing systemic corticosteroid therapy, given alongside antimicrobial regimens, in pediatric CAP (last search date December 31, 2024). Literature screening, quality assessment, and data extraction were conducted by 2 independent reviewers. Heterogeneity and publication bias were detected by I2 and Egger's tests. The data were pooled using the random-effects model for the conduction of meta-analysis.
RESULTS: Twenty-two articles (N = 75.353) of 3799 screened studies were included in the systematic review; 7 of 22 studies providing data on length of hospital stay (LOS) and duration of fever for corticosteroid-treated versus control patients were included in the meta-analysis. Significant heterogeneity was observed regarding the regimen, dosage and duration of corticosteroid therapy. Regarding meta-analysis, LOS and time to defervescence were significantly decreased in patients receiving corticosteroids compared to controls in randomized clinical trials (Cohen's d value = -0.59, 95% confidence interval: -0.96 to -0.23, P = 0.001 , I2 = 52.6%; Cohen's d value =-0.54, 95% confidence interval: -0.83 to -0.26, P < 0.001 , I2 = 26.1%, respectively), but not in observational studies. Corticosteroid administration was associated with a shorter radiologic and clinical recovery time especially for Mycoplasma pneumoniae and viral pneumonia with wheezing. Corticosteroid-related adverse events were infrequent and manageable.
CONCLUSIONS: Our analysis suggests a possible advantage for corticosteroid therapy in selected pediatric patients with CAP. Further studies are needed to clarify how, when, and where corticosteroids should be added to the treatment plan of pediatric CAP.
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