Transcript Dexamethasone and length of hospital stay in patients with

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 2011. 377: 2023-30.
No sources of funding cited
Presented By:
Deepa Patel
Doctor of Pharmacy Candidate, 2012
Mercer University COPHS
COMMON CAUSATIVE BACTERIA
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Typical
 S. pneumonia
 H. influenza
 M. catarrhalis
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Atypical
ANTIBIOTIC THERAPY
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Mainstay for treatment of
CAP includes broad spectrum
antibiotic(s) based on the
patient’s risk factors
 Doxycycline
 Macrolides
 C. pneumoniae
 Fluoroquinolones
 L. pneumophilia
 Cephalosporins
 M. pneumoniae
 Clindamycin
 Beta lactams
 Vancomycin
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Intravenous corticosteroids are frequently used in
sepsis/septic shock patients as they are potent inhibitors
of inflammation
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Previous studies have investigated the role of
corticosteroids in community acquired pneumonia,
though outcomes with dexamethasone had not been
studied
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Purpose: Assess the effect of intravenous dexamethasone
compared to placebo in length of hospital stay in nonimmunocompromised patients admitted to a hospital
with community acquired pneumonia
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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
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Nov 2007 to September 2010 in the Netherlands
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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
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Dexamethasone, along with other corticosteroids plays a
role in decreasing inflammation and expediting recovery
for patients with CAP
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Adverse effects abound with use of this class of
medications, including:
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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