Presentation on theme: "Dexamethasone and length of hospital stay in patients with community acquired pneumonia: a randomised, double-blind, placebo controlled trial Sabine C."— Presentation transcript:
1Dexamethasone and length of hospital stay in patients with community acquired pneumonia: a randomised, double-blind, placebo controlled trialSabine C A Meijvis, Hans Hardeman, Hilde H F Remmelts, Rik Heijlingenberg, Ger T Rijkers, Heleen van Velzen-Blad, G Paul Voorn, Ewoudt M W van de Garde, Henrik Endeman, Jan C Grutters, Willem Jan W Bos, Douwe H BiesmaThe Lancet. June :No sources of funding citedPresented By:Deepa PatelDoctor of Pharmacy Candidate, 2012Mercer University COPHS
2Community Acquired Pneumonia Common Causative bacteriaAntibiotic therapyMainstay for treatment of CAP includes broad spectrum antibiotic(s) based on the patient’s risk factorsDoxycyclineMacrolidesFluoroquinolonesCephalosporinsClindamycinBeta lactamsVancomycinTypicalS. pneumoniaH. influenzaM. catarrhalisAtypicalC. pneumoniaeL. pneumophiliaM. pneumoniae
4Background/PurposeIntravenous corticosteroids are frequently used in sepsis/septic shock patients as they are potent inhibitors of inflammationPrevious studies have investigated the role of corticosteroids in community acquired pneumonia, though outcomes with dexamethasone had not been studiedPurpose: Assess the effect of intravenous dexamethasone compared to placebo in length of hospital stay in non-immunocompromised patients admitted to a hospital with community acquired pneumonia
5Study Design 304 patients randomized and blinded 145 in control groupReceived placebo once daily for 4 days151 in experimental group5 mg dexamethasone once daily for 4 daysNov 2007 to September 2010 in the NetherlandsExclusion criteria: immunocompromised status, need for immediate transfer to ICU, and prior immunosuppressive medications
6ResultsSecondary outcomes favoring dexamethasone: greater decline in C-reactive protein and interleukin-6, and statistically significant improvement in social functioning at 30 days following discharge when compared to the placebo group.
7ConclusionUse of dexamethasone in addition to antibiotic therapy in patients hospitalized with community acquired pneumonia decreases length of hospital stay by 1 day (p=0.048) when compared to placebo
8CommentaryDexamethasone, along with other corticosteroids plays a role in decreasing inflammation and expediting recovery for patients with CAPAdverse effects abound with use of this class of medications, including:HyperglycemiaGI perforationGastric disturbancesSuperinfectionsTherefore, dexamethasone, and other corticosteroid, use should be judicious in the treatment of inpatient CAP, particularly in patients that have numerous comorbidities