Efficacy of methylprednisolone in children with severe community acquired pneumonia

• Published in: Pediatric pulmonology Vol. 48; no. 2; pp. 168 - 175
• Main Authors: Nagy, Bela, Gaspar, Imre, Papp, Agnes, Bene, Zsolt, Nagy Jr, Bela, Voko, Zoltan, Balla, Gyorgy
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.02.2013; Wiley Subscription Services, Inc
• Subjects: Anti-Bacterial Agents - therapeutic use; Anti-Inflammatory Agents - therapeutic use; C-Reactive Protein - analysis; C-Reactive Protein - drug effects; Child; Child, Preschool; childhood; community acquired pneumonia; Community-Acquired Infections - blood; Community-Acquired Infections - drug therapy; corticosteroid; Drug Therapy, Combination - methods; Female; Humans; imipenem; Imipenem - therapeutic use; Infant; Length of Stay; Leukocyte Count; Male; Methylprednisolone - therapeutic use; Pneumonia - blood; Pneumonia - drug therapy; Severity of Illness Index; Time Factors; Treatment Outcome
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.22574

Background The clinical value of adjuvant corticosteroid treatment in community‐acquired pneumonia (CAP) seemed to be controversial in adults, and even less data are available on the use of corticosteroids in children with CAP. Materials and Methods In this study, we investigated the efficacy of a 5‐day adjuvant methylprednisolone therapy to imipenem in 29 children with severe CAP. In parallel, 30 subjects with the same disease were treated with imipenem and placebo, and the two study groups were compared based on the different parameters of the primary and secondary end points. The primary end points were the duration of fever, the levels of white blood cells (WBC) and high sensitive C‐reactive protein (hsCRP). Secondary end points were the length of hospital stay, and the number of severe complications with or without surgical interventions. Results The additive methylprednisolone treatment significantly reduced the duration of fever with 2.5 days, the WBC counts (P = 0.014), the hsCRP levels showing a 48.7% decrease, and the length of hospital stay with 5.2 days versus the placebo group. Moreover, patients treated on imipenem alone had twice more complications and four times more invasive interventions compared to those on the combined therapy. Conclusions The 5‐day methylprednisolone therapy with imipenem was found effective in children having severe CAP. However, trials with larger cohorts are needed to study further beneficial effects of corticosteroids in children with CAP. Pediatr Pulmonol. 2013; 48:168–175. © 2012 Wiley Periodicals, Inc.