Research Spotlight: Treating Severe Community-Acquired Pneumonia with Steroids

Joshua Metlay, MD, PhD, chief of the Division of General Internal Medicine at Massachusetts General Hospital and professor of Medicine at Harvard Medical School, is the author of a recent commentary published in the New England Journal of Medicine, Time to Treat Severe Community-Acquired Pneumonia with Steroids?

What Question Were You Investigating?

This is an editorial commenting on the significance of a clinical trial that was published simultaneously in NEJM.

The trial, Hydrocortisone in Severe Community-Acquired Pneumonia, indicates a strong mortality reduction for patients with severe community acquired pneumonia (CAP) who received steroids in addition to antibiotics.

This is a long-standing question and recent guidelines have not recommended steroids in this situation but this trial changes the answer and this editorial (written by the two lead authors of the main pneumonia guideline in the US) endorses the use of steroids in this setting.

The 2019 guidelines for treating CAP by the American Thoracic Society and the Infectious Diseases Society of America were the first to address the role of glucocorticoids as adjunct therapy. The guidelines committee, which Dr. Metlay-co chaired, did not recommend the use of glucocorticoids for most CAP patients at that time, due to a lack of quality evidence pointing to a meaningful clinical benefit.

However, the results of this trial are sufficient to endorse the use of steroids in this setting, write Metlay and co-author Grant Waterer, MD, PhD, of the Royal Perth Hospital and the University of Western Australia in the editorial accompanying the study.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.