Corticosteroids Could Play Significant Role in Managing Community-Acquired Pneumonia

Corticosteroids were found to potentially play a major role in treating patients’ severe community-acquired pneumonia (sCAP), according to data from a study published in the Journal of the Intensive Care Society.¹ However, with conflicting study results and guideline recommendations, corticosteroids for treating sCAP—particularly hydrocortisone—need to be explored further.

“The use of systemic corticosteroids in CAP has been a subject of debate for years because the exact mechanism by which corticosteroids reduce mortality remains unclear,” wrote the authors of study findings published in the Cleveland Clinic Journal of Medicine.² “It has been postulated that corticosteroids may reduce the inflammatory response in the lungs, thereby promoting earlier resolution of CAP and preventing the development of or progression to acute respiratory distress syndrome, ultimately reducing mortality.”

According to the authors of the current study, sCAP is defined as a case of pneumonia within 48 hours of a hospital admission that requires emergency care, mechanical ventilation, or vasopressor medications.¹

Although it is not significantly prominent among the global population, sCAP can be a major issue for adults 65 and over. Among these patients, sCAP is common and leads to hospitalization for 2%. Additionally, adults 65 and over who are hospitalized have a 6% 30-day mortality rate.³

READ MORE: Capvaxive Shows Immune Responses to All 21 Serotypes for Children, Adolescents

The CDC recommends that all adults 50 and older receive a pneumococcal conjugate vaccine (PCV) to stay protected against sCAP.⁴ However, as the disease can significantly impact older adults and cause hospitalizations among this population, researchers are currently exploring ways of treating sCAP if vaccination is unsuccessful.

“There is no established consensus for the use of corticosteroids in sCAP and inconsistency between guidelines,” wrote the authors of the current study.¹ “This narrative review of recent literature and guidelines seeks to provide more clarity on the role of corticosteroid prescriptions in bacterial and non–COVID-19 viral sCAP.”

The researchers conducted a full-scope, narrative review of corticosteroids for sCAP. They detailed the current evidence, guidelines, and standards of practice in health care today, specifically in the intensive care unit (ICU). After presenting the existing literature, the researchers explored the efficacy of various corticosteroids and their commonly associated adverse events.

Throughout much of the current evidence, the use of corticosteroids for treating sCAP is unclear. Data from many previous clinical trials have shown reductions in mortality and hospital admission among patients taking corticosteroids for sCAP, but other trial data have shown little to no clinical benefits in this drug class, or even exacerbated outcomes among adult patients.¹

However, a particular corticosteroid, hydrocortisone, emerged throughout these studies as having significant benefits among patients experiencing sCAP, especially those with septic shock. Although the drug's benefits have led to ICU recommendation updates for hydrocortisone’s treatment of sCAP, the various guidelines provided by accredited health care organizations also display a lack of consensus.

Among the 8 guidelines that researchers of the current study explored, half recommended corticosteroids for sCAP, while the other half did not. Furthermore, the ones that recommended this drug class did so under specific conditions, such as if the patient presents with shock or does not have specific infectious diseases.

The consensus to use corticosteroids for sCAP, like the guideline recommendations, varies. According to the current study, evidence from a previous survey indicated that 51% of physicians use corticosteroids routinely in sCAP management.

“Current evidence suggests that corticosteroids, particularly hydrocortisone, may have a potential role in the management of sCAP,” they continued.¹ “However, recent trials have produced conflicting results, and the guidelines differ in their recommendations.”

Regarding future considerations for best practices in treating sCAP with corticosteroids, the literature is too far from a consensus for the researchers to offer a conclusive recommendation. With more to be understood in terms of treatment failures, overall sCAP development, and the efficacy of corticosteroids, future trials are necessary before the proper stakeholders will be confident in providing a universal recommendation for this disease and drug class.

“Some guidelines endorse their use, while others provide conditional recommendation or advise against it,” concluded the authors.¹ “Given these discrepancies, current practice is formed by individual opinions and personal preferences. Further research is required to allow for more robust conclusions and guidance.”

READ MORE: Pneumococcal Resource Center

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REFERENCES

1. Terrington I, Cox O, Copley P, et al. The role of corticosteroids in the management of non-COVID-19 severe community-acquired pneumonia in the intensive care unit: a narrative review. J Intensive Care Soc. Published online September 27, 2025. doi:10.1177/17511437251374816

2. Chapa-Rodriguez A, Abou-Elmagd T, O’Rear C, et al. Do patients with severe community-acquired bacterial pneumonia benefit from systemic corticosteroids? Cleve Clin J Med. 2025;92(10):600-604. doi:10.3949/ccjm.92a.25023

3. Womack J, Kropa J. Community-acquired pneumonia in adults: rapid evidence review. Am Fam Physician. 2022;105(6):625-630. Accessed October 2, 2025. https://www.aafp.org/pubs/afp/issues/2022/0600/p625.html

4. Pneumococcal vaccine recommendations. CDC. October 26, 2024. Accessed October 2, 2025. https://www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/index.html