Presentation on theme: "Sabine 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,"— Presentation transcript:
Sabine 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 Biesma The Lancet. June : No sources of funding cited Presented By: Deepa Patel Doctor of Pharmacy Candidate, 2012 Mercer University COPHS
COMMON CAUSATIVE BACTERIA Typical S. pneumonia H. influenza M. catarrhalis Atypical C. pneumoniae L. pneumophilia M. pneumoniae ANTIBIOTIC THERAPY Mainstay for treatment of CAP includes broad spectrum antibiotic(s) based on the patients risk factors Doxycycline Macrolides Fluoroquinolones Cephalosporins Clindamycin Beta lactams Vancomycin
Intravenous corticosteroids are frequently used in sepsis/septic shock patients as they are potent inhibitors of inflammation Previous studies have investigated the role of corticosteroids in community acquired pneumonia, though outcomes with dexamethasone had not been studied Purpose: 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
304 patients randomized and blinded 145 in control group Received placebo once daily for 4 days 151 in experimental group 5 mg dexamethasone once daily for 4 days Nov 2007 to September 2010 in the Netherlands Exclusion criteria: immunocompromised status, need for immediate transfer to ICU, and prior immunosuppressive medications
Secondary 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.
Use 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
Dexamethasone, along with other corticosteroids plays a role in decreasing inflammation and expediting recovery for patients with CAP Adverse effects abound with use of this class of medications, including: Hyperglycemia GI perforation Gastric disturbances Superinfections Therefore, dexamethasone, and other corticosteroid, use should be judicious in the treatment of inpatient CAP, particularly in patients that have numerous comorbidities