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:
1 Dexamethasone 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
2 Community 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
4 Background/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
5 Study 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
6 ResultsSecondary 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.
7 ConclusionUse 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
8 CommentaryDexamethasone, 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